Clinical question: Restaging lung cancer. Signs and symptoms: Staging lung cancer. Pre and post enhanced brain MRI:No diffusion-weighted abnormalities.Examination demonstrates several small foci of subcortical and periventricular FLAIR/T2 hyperintensity in bilateral cerebral hemispheres. Minimal similar signal changes in bilateral basal ganglia is also noted. Findings are nonspecific, nonhemorrhagic and demonstrate no enhancement. This appearance however in this age group is often result of microvascular ischemic changes.. Unremarkable cerebral cortex, cortical sulci, ventricular system and CSF spaces otherwise.The signal void of major intracranial arterial branches are identified.There is no detectable abnormal parenchymal or leptomeningeal enhancement to suggest metastatic disease.The signal intensity of intracranial venous sinuses are within normal and the normal pattern of enhancement.Calvarium demonstrate normal signal intensity and without abnormal enhancement. Unremarkable images through the orbits and including axial fat sat post enhanced series.Paranasal sinuses remain well pneumatized. There is however a small focus of chronic mucosal thickening in the midline of inferior aspect of frontal sinuses.
1.No evidence of metastatic disease.2.Negative diffusion-weighted series and findings suggestive of mild chronic nonhemorrhagic small vessel ischemic strokes as detailed.