Diagnosis: Secondary malignant neoplasm of brain and spinal cord(198.3)Malignant neoplasm of bronchus and lung, unspecified siteClinical question: Hx of metastatic lung cancer s/p craniotomy and SRS, surveillance MRI The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post left-sided craniotomy. There is T2 and FLAIR signal hyperintensity centered in the left middle temporal gyrus anteriorly which is associated with some susceptibility effect.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. This is stable compared to the previous exam.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.The patient is status post left-sided craniotomy for left temporal lobe surgery. 2.There is no evidence for intracranial metastases at this time.3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.