Male, 63 years old, history of lung cancer with brain metastases. Since the prior examination, patchy ependymal enhancement has developed along the bodies of the lateral ventricles. Minimal ependymal enhancement at the frontal horns is relatively unchanged. No definite intraparenchymal enhancing lesions are seen. No enhancement of the cranial nerves is detected.Extensive confluent white matter T2 hyperintensity is unchanged. No evidence of generalized mass effect is seen. No acute intracranial hemorrhage or any abnormal extra-axial fluid collections are detected. Ventricular size and morphology are unchanged.
Interval development of ependymal enhancement along the bodies of the lateral ventricles raises concern for progressive intracranial metastatic disease. Treatment related changes do not typically present in this way and are therefore considered less likely. However, an inflammatory or infectious process is not entirely excluded.