Intracerebral metastases other imaging findings: Difference between revisions
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==Overview== | ==Overview== | ||
Other imaging tests for intracerebral metastases include [[Nuclear magnetic resonance spectroscopy|magnetic resonance spectroscopy]] (intratumoural [[choline]] and [[lipid]] peak with depleted [[N-Acetylaspartate|N-acetylaspartate]]), [[Perfusion weighted imaging|magnetic resonance perfusion]] (reduced cerebral blood volume and cerebral blood flow in the region of [[metastasis]]), and [[PET|positron emission tomography]] (hypermetabolic, hypometabolic, or variable metabolism depending on the primary).<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><ref name=nuclear1>Nuclear medicine for brain metastasis. Dr Bruno Di Muzio and Dr Trent Orton et al. Radiopaedia 2015. http://radiopaedia.org/articles/brain-metastases. Accessed on November 13, 2015</ref> | |||
==Other Imaging Findings== | ==Other Imaging Findings== | ||
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*[[Nuclear magnetic resonance spectroscopy|MR spectroscopy]] may be helpful in the diagnosis of intracerebral metastases.<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> | *[[Nuclear magnetic resonance spectroscopy|MR spectroscopy]] may be helpful in the diagnosis of intracerebral metastases.<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> | ||
*Findings on [[Nuclear magnetic resonance spectroscopy|MR spectroscopy]] include:<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> | *Findings on [[Nuclear magnetic resonance spectroscopy|MR spectroscopy]] include:<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> | ||
:* | :*Intratumoral [[choline]] peak with no choline elevation in the peritumoral edema | ||
:*Any tumor necrosis results in a [[lipid]] peak | :*Any tumor necrosis results in a [[lipid]] peak | ||
:*[[N-Acetylaspartate]] (NAA) depleted | :*[[N-Acetylaspartate|N-acetylaspartate]] (NAA) depleted | ||
===Magnetic Resonance Perfusion=== | ===Magnetic Resonance Perfusion=== | ||
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Image:MR perfusion of brain metastasis 2.jpg|<sub>MR perfusion of brain of a case of renal cell carcinoma demonstrates highly variable appearance of hemorrhagic metastases to the brain.<ref name=MRPbarinmets1>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:MR perfusion of brain metastasis 2.jpg|<sub>MR perfusion of brain of a case of renal cell carcinoma demonstrates highly variable appearance of hemorrhagic metastases to the brain.<ref name=MRPbarinmets1>Image courtesy of Dr. Frank Gaillard. Radiopaedia (original file [http://radiopaedia.org/cases/cerebral-metastases-rcc here]). Creative Commons BY-SA-NC</ref></sub> | ||
</gallery> | |||
</ | ===Positron Emission Tomography=== | ||
'''1. Fludeoxyglucose F 18-positron emission tomography (FDG-PET)''' | |||
*[[Fludeoxyglucose F 18|Fludeoxyglucose F 18-positron emission tomography]] is generally considered as the best imaging tool for [[metastases]].<ref name=nuclear1>Nuclear medicine for brain metastasis. Dr Bruno Di Muzio and Dr Trent Orton et al. Radiopaedia 2015. http://radiopaedia.org/articles/brain-metastases. Accessed on November 13, 2015</ref> | |||
*However, it can only detect metastases upto 1.5 cm in size, therefore contrast MRI remains the gold standard to rule out small metastases. Lung, breast, colorectal, head and neck, melanoma, and thyroid metastases are usually hypermetabolic. | |||
*Mucinous adenocarcinoma and renal cell carcinoma are typically hypometabolic. | |||
*[[Gliomas]] and [[lymphomas]] are variable. | |||
*Any central hypometabolism indicates [[necrosis]]. | |||
'''2. Positron emission tomography/computed tomography (PET/CT)''' | |||
*PET/CT may have higher sensitivity in detecting [[metastases]], partly due to hybrid imaging part, computed tomography (CT). | |||
*It may even demonstrate asymptomatic metastases in patients examined for extracranial disease. | |||
==References== | ==References== | ||
Latest revision as of 13:55, 24 November 2015
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Intracerebral metastases Microchapters |
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Differentiating Intracerebral Metastases from other Diseases |
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Diagnosis |
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Treatment |
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Case Studies |
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Intracerebral metastases other imaging findings On the Web |
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American Roentgen Ray Society Images of Intracerebral metastases other imaging findings |
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Risk calculators and risk factors for Intracerebral metastases other imaging findings |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sujit Routray, M.D. [2]
Overview
Other imaging tests for intracerebral metastases include magnetic resonance spectroscopy (intratumoural choline and lipid peak with depleted N-acetylaspartate), magnetic resonance perfusion (reduced cerebral blood volume and cerebral blood flow in the region of metastasis), and positron emission tomography (hypermetabolic, hypometabolic, or variable metabolism depending on the primary).[1][2]
Other Imaging Findings
Magnetic Resonance Spectroscopy
- MR spectroscopy may be helpful in the diagnosis of intracerebral metastases.[1]
- Findings on MR spectroscopy include:[1]
- Intratumoral choline peak with no choline elevation in the peritumoral edema
- Any tumor necrosis results in a lipid peak
- N-acetylaspartate (NAA) depleted
Magnetic Resonance Perfusion
- MR perfusion demonstrates reduced CBV (cerebral blood volume) and CBF (cerebral blood flow) in the region of metastasis. Surrounding edema demonstrates normal CBV.[3]
Gallery
-
![MR perfusion of brain of a known case of renal cell carcinoma demonstrates reduced CBV (cerebral blood volume) and CBF (cerebral blood flow) in the region of metastasis. Surrounding edema demonstrates normal CBV.[4]](/images/3/33/MR_perfusion_of_brain_metastasis_1.jpg)
MR perfusion of brain of a known case of renal cell carcinoma demonstrates reduced CBV (cerebral blood volume) and CBF (cerebral blood flow) in the region of metastasis. Surrounding edema demonstrates normal CBV.[4]
-
![MR perfusion of brain of a case of renal cell carcinoma demonstrates highly variable appearance of hemorrhagic metastases to the brain.[4]](/images/9/97/MR_perfusion_of_brain_metastasis_2.jpg)
MR perfusion of brain of a case of renal cell carcinoma demonstrates highly variable appearance of hemorrhagic metastases to the brain.[4]
![MR perfusion of brain of a known case of renal cell carcinoma demonstrates reduced CBV (cerebral blood volume) and CBF (cerebral blood flow) in the region of metastasis. Surrounding edema demonstrates normal CBV.[4]](/index.php/File:MR_perfusion_of_brain_metastasis_1.jpg)
![MR perfusion of brain of a case of renal cell carcinoma demonstrates highly variable appearance of hemorrhagic metastases to the brain.[4]](/index.php/File:MR_perfusion_of_brain_metastasis_2.jpg)
Positron Emission Tomography
1. Fludeoxyglucose F 18-positron emission tomography (FDG-PET)
- Fludeoxyglucose F 18-positron emission tomography is generally considered as the best imaging tool for metastases.[2]
- However, it can only detect metastases upto 1.5 cm in size, therefore contrast MRI remains the gold standard to rule out small metastases. Lung, breast, colorectal, head and neck, melanoma, and thyroid metastases are usually hypermetabolic.
- Mucinous adenocarcinoma and renal cell carcinoma are typically hypometabolic.
- Gliomas and lymphomas are variable.
- Any central hypometabolism indicates necrosis.
2. Positron emission tomography/computed tomography (PET/CT)
- PET/CT may have higher sensitivity in detecting metastases, partly due to hybrid imaging part, computed tomography (CT).
- It may even demonstrate asymptomatic metastases in patients examined for extracranial disease.
References
- ↑ 1.0 1.1 1.2 Radiographic MRI features of brain metastasis. Bruno Di Muzio and Dr Trent Orton et al. Radiopaedia 2015. http://radiopaedia.org/articles/brain-metastases
- ↑ 2.0 2.1 Nuclear medicine for brain metastasis. Dr Bruno Di Muzio and Dr Trent Orton et al. Radiopaedia 2015. http://radiopaedia.org/articles/brain-metastases. Accessed on November 13, 2015
- ↑ MRI brain of cerebral metastases - RCC. Dr Frank Gaillard. Radiopaedia 2015. http://radiopaedia.org/cases/cerebral-metastases-rcc. Accessed on November 13, 2015
- ↑ 4.0 4.1 Image courtesy of Dr. Frank Gaillard. Radiopaedia (original file here). Creative Commons BY-SA-NC