Intracerebral metastases MRI: Difference between revisions

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==Overview==
==Overview==
Brain MRI is helpful in the diagnosis of intracerebral metastases. On MRI, intracerebral metastases are characterized by iso- to hypointensity on T1-weighted imaging and hyperintense portion on T2-weighted imaging. On contrast administration, intense enhancement is observed (uniform, punctate, or ring-enhancing). Peritumoral [[edema]] which is out of proportion with tumor size is observed on diffusion weighted imaging.<ref name=mriofbrainmets1>Radiographic MRI features of brain metastasis. Bruno Di Muzio and Dr Trent Orton et al. Radiopaedia 2015. http://radiopaedia.org/articles/brain-metastases</ref>


==MRI==
==MRI==
*On MRI, brain metastases are typically found in the watershed areas of the brain (areas where blood vessels narrow and act as a trap for clumps of tumor cells).<ref name="Khuntia2015">{{cite journal|last1=Khuntia|first1=Deepak|title=Contemporary Review of the Management of Brain Metastasis with Radiation|journal=Advances in Neuroscience|volume=2015|year=2015|pages=1–13|issn=2356-6787|doi=10.1155/2015/372856}}</ref>
*On MRI, brain metastases are typically found in the watershed areas of the brain (areas where blood vessels narrow and act as a trap for clumps of tumor cells).<ref name="Khuntia2015">{{cite journal|last1=Khuntia|first1=Deepak|title=Contemporary Review of the Management of Brain Metastasis with Radiation|journal=Advances in Neuroscience|volume=2015|year=2015|pages=1–13|issn=2356-6787|doi=10.1155/2015/372856}}</ref>
*Findings on MRI suggestive of intracerebral metastases are tabulated below:<ref name=mriofbrainmets1>Radiographic MRI features of brain metastasis. Bruno Di Muzio and Dr Trent Orton et al. Radiopaedia 2015. http://radiopaedia.org/articles/brain-metastases</ref>


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Image:Brain metastases MRT-T1WI.jpg|<sub>Brain metastasis in the right cerebral hemisphere from lung cancer shown on T1-weighted magnetic resonance imaging with intravenous contrast.<ref name=brainmetastasisimage1>MRI image of brain metastasis. Wikipedia 2015. https://en.wikipedia.org/wiki/Brain_metastasis. Accessed on November 9, 2015</ref></sub>
Image:Brain metastases MRT-T1WI.jpg|<sub>Brain metastasis in the right cerebral hemisphere from lung cancer shown on T1-weighted magnetic resonance imaging with intravenous contrast.<ref name=brainmetastasisimage1>MRI image of brain metastasis. Wikipedia 2015. https://en.wikipedia.org/wiki/Brain_metastasis. Accessed on November 9, 2015</ref></sub>
Image:MRI of brain metastasis 1.jpg|<sub>Coronal T1 C+ head within the parieto-occipital region on the left demonstrates a very rounded brightly peripherally enhancing mass located near the grey-white junction, surrounded by a moderate amount of vasogenic edema. The central region of lower signal intensity does not enhance nor does it restrict. Features are consistent with the patient's known metastatic disease with bull's eye sign.<ref name=mriimage1>Image courtesy of Dr. Frank Gaillard. Radiopaedia (original file [http://radiopaedia.org/cases/bulls-eye-sign-from-cerebral-metastasis here]). Creative Commons BY-SA-NC</ref></sub>
Image:MRI of brain metastasis 1.jpg|<sub>Coronal T1 C+ head within the parieto-occipital region on the left demonstrates a very rounded brightly peripherally enhancing mass located near the grey-white junction, surrounded by a moderate amount of vasogenic edema. The central region of lower signal intensity does not enhance nor does it restrict. Features are consistent with the patient's known metastatic disease with bull's eye sign.<ref name=mriimage1>Image courtesy of Dr. Frank Gaillard. Radiopaedia (original file [http://radiopaedia.org/cases/bulls-eye-sign-from-cerebral-metastasis here]). Creative Commons BY-SA-NC</ref></sub>
Image:MRI of brain metastasis 2.jpg|<sub>Axial T2 MRI scan of 60 year old female with known history of malignant melanoma, complaining of acute right hemiplegia, aphasia, and confusion, demonstrates a large cerebral haematoma with a fluid-fluid level. There is a smaller low signal area anteriorly which corresponded to the known metastasis. This smaller area enhanced after gadolinium, as did the overlying dura.<ref name=mriimage2>Image courtesy of Dr. Laughlin Dawes. Radiopaedia (original file [http://radiopaedia.org/cases/melanoma-metastasis-2 here]). Creative Commons BY-SA-NC</ref></sub>
Image:MRI of brain metastasis 3.jpg|<sub>Axial T1 MRI scan of an elderly patient with history of small cell lung cancer, presenting with increasing headaches, demonstrates multiple cystic cerebral metastases.<ref name=mriimage3>Image courtesy of Dr. Frank Gaillard. Radiopaedia (original file [http://radiopaedia.org/cases/cerebral-metastases-1 here]). Creative Commons BY-SA-NC</ref></sub>
Image:MRI of brain metastasis 4.jpg|<sub>MRI head with contrast in a known case of renal cell carcinoma demonstrates multiple, large, well-defined, round, solid-cystic, peripheral irregular enhancement mass lesions involving left cerebral hemisphere and corpus callosum, crossing the midline anteriorly. Areas of necrosis and hemorrhage are seen within the lesion. Associated mass effect and moderate peritumoral edema is observed.<ref name=mriimage4>Image courtesy of Dr. Frank Gaillard. Radiopaedia (original file [http://radiopaedia.org/cases/cerebral-metastases-rcc here]). Creative Commons BY-SA-NC</ref></sub>
Image:MRI of brain metastasis 5.jpg|<sub>A 40 year old female previously operated for metastatic brain lesion from Ca thyroid presents with altered sensorium. Patient earlier had thyroidectomy 1 year ago. Axial T2 MRI scan reveals left parietal lobe lesion with adjacent perilesional edema with an skull vault lesion at the previous craniotomy site. Skull vault lesion shows intense homogeneous enhancement.<ref name=mriimage5>Image courtesy of Dr. Paresh K Desai. Radiopaedia (original file [http://radiopaedia.org/cases/metastases-from-follicular-carcinoma-thyroid here]). Creative Commons BY-SA-NC</ref></sub>
Image:MRI of brain metastasis 6.jpg|<sub>T1-weighted MRI head of a 65 year old male with advanced breast cancer demonstrates bilateral thalamic (and some smaller peripheral) metastases. The larger, partly cystic lesion on the right traverses the midline across the third ventricle.<ref name=mriimage6>Image courtesy of Dr. Roberto Schubert. Radiopaedia (original file [http://radiopaedia.org/cases/brain-metastases-involving-the-interthalamic-adhesion here]). Creative Commons BY-SA-NC</ref></sub>
Image:MRI of brain metastasis 7.jpg|<sub>Axial FLAIR MRI head of a 60 year old male with known history of advanced colorectal cancer demonstrates multiple intracerebral metastases.<ref name=mriimage7>Image courtesy of Dr. M Shebl. Radiopaedia (original file [http://radiopaedia.org/cases/cerebral-metastases-colorectal-cancer here]). Creative Commons BY-SA-NC</ref></sub>
Image:MRI of brain metastasis 8.jpg|<sub>Sagital T1-weighted MRI head of a 39 year old middle eastern female with breast cancer, complaining of headache and confusion, demonstrates multiple small scattered intraparenchymal ring enhancing lesions proved to be metastatic deposits.<ref name=mriimage8>Image courtesy of Dr. Ahmed Abd Rabou. Radiopaedia (original file [http://radiopaedia.org/cases/cerebral-metastasis-1 here]). Creative Commons BY-SA-NC</ref></sub>
Image:MRI of brain metastasis 9.jpg|<sub>Axial T1-weighted MRI head with contrast of a 58 year old middle eastern male with pancoast tumor (adenocarcinoma), complaining of headache, vomiting, and syncopal attacks, demonstrates left cerebellar cystic lesion with fluid level with T1 hyperintense signal, likely hemorrhage. They show rim enhancement after contrast and surrounded by brain edema exerting mass effect upon the left lateral ventricle and left aspect of pons.<ref name=mriimage9>Image courtesy of Dr. Ahmed Abd Rabou. Radiopaedia (original file [http://radiopaedia.org/cases/pancoast-tumour-with-cystic-cerebral-metastasis here]). Creative Commons BY-SA-NC</ref></sub>


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Latest revision as of 20:13, 13 November 2015

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sujit Routray, M.D. [2]

Overview

Brain MRI is helpful in the diagnosis of intracerebral metastases. On MRI, intracerebral metastases are characterized by iso- to hypointensity on T1-weighted imaging and hyperintense portion on T2-weighted imaging. On contrast administration, intense enhancement is observed (uniform, punctate, or ring-enhancing). Peritumoral edema which is out of proportion with tumor size is observed on diffusion weighted imaging.[1]

MRI

  • On MRI, brain metastases are typically found in the watershed areas of the brain (areas where blood vessels narrow and act as a trap for clumps of tumor cells).[2]
  • Findings on MRI suggestive of intracerebral metastases are tabulated below:[1]
MRI component Findings

T1

  • Typically iso- to hypointense
  • If hemorrhagic, may have intrinsic high signal
  • Non-hemorrhagic melanoma metastases can also have intrinsic high signal due to the paramagnetic properties of melanin

T1 with contrast

  • Enhancement pattern can be uniform, punctate, or ring-enhancing, but it is usually intense
  • Delayed sequences may show additional lesions, therefore contrast-enhanced MRI is the current standard for small metastases detection

T2

  • Typically hyperintense
  • Hemorrhage may alter this (hypointense)

FLAIR

  • Typically hyperintense with hyperintense peri-tumoral edema

Diffusion weighted imaging (DWI)

  • Edema is out of proportion with tumor size and appears dark on trace-weighted DWI

Gallery

References

  1. 1.0 1.1 Radiographic MRI features of brain metastasis. Bruno Di Muzio and Dr Trent Orton et al. Radiopaedia 2015. http://radiopaedia.org/articles/brain-metastases
  2. Khuntia, Deepak (2015). "Contemporary Review of the Management of Brain Metastasis with Radiation". Advances in Neuroscience. 2015: 1–13. doi:10.1155/2015/372856. ISSN 2356-6787.
  3. MRI image of brain metastasis. Wikipedia 2015. https://en.wikipedia.org/wiki/Brain_metastasis. Accessed on November 9, 2015
  4. Image courtesy of Dr. Frank Gaillard. Radiopaedia (original file here). Creative Commons BY-SA-NC
  5. Image courtesy of Dr. Laughlin Dawes. Radiopaedia (original file here). Creative Commons BY-SA-NC
  6. Image courtesy of Dr. Frank Gaillard. Radiopaedia (original file here). Creative Commons BY-SA-NC
  7. Image courtesy of Dr. Frank Gaillard. Radiopaedia (original file here). Creative Commons BY-SA-NC
  8. Image courtesy of Dr. Paresh K Desai. Radiopaedia (original file here). Creative Commons BY-SA-NC
  9. Image courtesy of Dr. Roberto Schubert. Radiopaedia (original file here). Creative Commons BY-SA-NC
  10. Image courtesy of Dr. M Shebl. Radiopaedia (original file here). Creative Commons BY-SA-NC
  11. Image courtesy of Dr. Ahmed Abd Rabou. Radiopaedia (original file here). Creative Commons BY-SA-NC
  12. Image courtesy of Dr. Ahmed Abd Rabou. Radiopaedia (original file here). Creative Commons BY-SA-NC


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