Female, 53 years old, with history of non-small cell lung cancer, outside hospital CT showing a small brain lesion. A lobular, partially enhancing lesion is present at the junction of the left parietal and temporal lobes which measures up to 10 mm in maximal diameter. The lesion contains bubbly areas of T1 and T2 hyperintensity internally, with a T2 hypointense rim and strong associated susceptibility artifact. The lesion correlates with one noted on the prior outside CT which demonstrates intrinsic hyperattenuation suggesting either mineralization or blood product. This lesion was not evident on older examinations from 2007 or 2009. MR spectroscopy of the lesion was not performed as the strong associated susceptibility effect prevents reliable assessment.The above-described lesion is associated with little if any edema and no significant mass effect. No additional enhancing lesions are seen. Note is made of numerous scattered T2 hyperintense lesions in the periventricular and subcortical white matter of the bilateral cerebral hemispheres. Note is also made of two additional foci of susceptibility, one in the left frontal lobe and one in the right frontal lobe, without edema or mass effect.No abnormal extra-axial collections are detected. The ventricular system is normal in size and morphology.
A lesion is identified at the junction of the left parietal and temporal lobes with MRI and CT characteristics suggesting associated mineralization and/or blood product. Some of the features of this lesion are suggestive of a cavernous malformation, which is supported by the history of brain radiation and the presence of two additional susceptibility inducing foci. While enhancement is typically absent or minimal with cavernomas, recent hemorrhage could account for the somewhat greated than normal degree of enhancement seen on this exam. The possibility that this lesion represents either a hemorrhagic, or mineralized treated metastasis can also be considered. However, the lack of significant edema and mass effect would argue against active neoplastic disease.Due to the presence of strong susceptibility artifact, MRS is not a viable imaging modality for this lesion. Close interval follow-up should be considered, with brain PET as an additional diagnostic option for consideration.