4.1b. Pre-contrast Axial T1 Wtd MRI 4.1c. Post-contrast Axial T1 Wtd MRI4.1a. Axial T2 Wtd MRI

4.1d. Post-contrast Sagittal T1 Wtd MRI

Patient with Intra-cranial mass.

Q1. Diagnosis Please

4.2a. Post-contrast Axial T1 Wtd MRI 4.2b. Post-contrast Coronal T1 Wtd MRI

Patient with multiple Intra-cranial masses. Q2. Diagnosis Please

Abnormal MRI

Q3. Diagnosis Please

4.3b. Post-contrast Axial T1 Wtd MRI 4.3c. Post-contrast Coronal T1 Wtd MRI4.3a. Pre-contrast Axial T1 Wtd MRI

4.3d. Post-contrast Sagittal T1 Wtd MRI

4.4. Post-contrast Coronal T1 Wtd MRI

Abnormal MRI with dural masses

Q4. Diagnosis Please

4.5. Post-contrast Axial T1 Wtd MRI

Abnormal MRI

Q5. Diagnosis Please

Fig. 4.1 Fig. 4.2 Fig. 4.3

Fig. 4.4 Fig. 4.5

Cases 4.1 through 4.5 share a common diagnosis.

Name the common diagnosis.

Fig. 4.1 Fig. 4.2 Fig. 4.3

Fig. 4.4 Fig. 4.5

Cases 4.1 through 4.5 share a common diagnosis.

Name the common diagnosis.

METASTASES TO THE BRAIN

4.1b. Pre-contrast Axial T1 Wtd MRI 4.1c. Post-contrast Axial T1 Wtd MRI4.1a. Axial T2 Wtd MRI

4.1d. Post-contrast Sagittal T1 Wtd MRI

56-year old lady with a history of Breast carcinoma presented with 1-month history of increased difficulty in word finding.

Findings: A well-defined enhancing tumor (arrow) is seen within the left frontal lobe with surrounding edema (E in figure A)

Diagnosis: Solitary metastatic adenocarcinoma to the brain from breast primary.

E

40-year old lady with a history of breast carcinoma diagnosed 6 years ago, presented with headache and ataxia.

Findings: Shower of at least 30 metastatic enhancing lesions are seen closely packed together within both Cerebellar hemispheres (yellow arrows) and few lesions also seen within both posterior Fronto-parietal lobes (red arrows)

Diagnosis:Multiple metastasis to the brain from breast primary

28-year old male with melanoma presented with severe headaches, treated by chiropractor without relief, and also with blurred vision progressed to diplopia.

4.3b. Post-contrast Axial T1 Wtd MRI 4.3c. Post-contrast Coronal T1 Wtd MRI4.3a. Pre-contrast Axial T1 Wtd MRI

4.3d. Post-contrast Sagittal T1 Wtd MRI

Findings: Linear enhancement of the subarachnoid space outlining the cerebellar sulci (yellow arrows) and cortical sulci (red arrows). Note the pathology is not seen in non-contrast study (A).

Findings: Linear enhancement of the subarachnoid space outlining the cerebellar sulci (arrows in B, C, D) and cortical sulci (small arrows in C,D). Note the pathology is not seen in non-contrast study (A).

Diagnosis:Leptomeningeal/subarachnoid spread of melanoma metastasis, proven by cerebrospinal fluid cytology.

4.4. Post-contrast Coronal T1 Wtd MRI

69-year old male with prostate cancer diagnosed 7 years ago, presented with right sided hemiparesis.

Findings: Multiple enhancing dural masses involving the left frontal dura (short arrow) and left temporal dura (long arrow) with calvarial metastases (red arrows).

Diagnosis:Dural metastases from prostrate carcinoma

50-year old male with renal cell carcinoma

Diagnosis:Right temporal calvarial metastasis with a small epidural tumor (arrow head) and an intraventricular metastasis (arrows).

Fig. 4.1 Fig. 4.3

Fig. 4.4 Fig. 4.5

Common primary sites: Lung, Breast, Melanoma, Thyroid, Renal Cell Carcinoma

METASTASES TO THE BRAIN

Patten of involvement:

• Intraparenchymal (Figure 4.1)

• Leptomeningial/Subarachnoid Spread (Figure 4.3)

• Dural (Figure 4.4)

• Epidural (Figure 4.5)

• Intraventricular (Figure 4.5)

Hemorrhagic Metastases

•Renal

•Breast

•Melanoma

•Choriocracinoma

MRI is more sensitive than CT imaging to detect metastatic lesions and can detect a lesion as small as a dot (2mm).