63 years, Male, with a history of small cell lung cancer and numerous brain metastases now status post chemotherapy. Evidence of treatment response with multiple previously seen enhancing lesions no longer appreciated. Interval postsurgical changes from left frontoparietal and right parietal approach. The left posterior frontal resection cavity is filled with blood products and there is minimal residual nodular enhancement in the posterior aspect of the middle frontal gyrus that may be consistent with residual metastasis. The right temporoparietal cavity has nodular enhancement in its medial aspect suggestive of residual tumor. There is new susceptibility effect in the region of the previously seen right cerebellar and right posterior temporal metastases and may be related to mineralization and/or chronic blood products.The left frontal calvarial lesion is smaller measuring 5 mm versus previously 12 mm. The enhancing nodule within the right paraspinal muscles remains, but is incompletely visualized on this exam.Redemonstration of encephalomalacia in the bilateral basal ganglia and corona radiata. There is no evidence of acute ischemia. There is mild diffuse cerebral volume loss. There is no mass effect, edema, hydrocephalus or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There are secretions and mucosal thickening throughout the left maxillary sinus.
1. Evidence of treatment response with marked regression of previously seen multiple supratentorial and infratentorial lesions. Small residual areas of enhancement are seen along the margin of the right temporal parietal resection cavity as well as just lateral to the left posterior frontal resection cavity. 2. Left frontal calvarial enhancing lesion is also smaller. Previously seen right paraspinous soft tissue lesion is partially imaged.3. No significant edema or evidence of intracranial mass effect on the current study.