brain metastasis

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CASE HISTORY : 

CASE HISTORY 58 Yr old Male pt. Chest & TB / 16 CR No. 115538 K/c/o Ca Lung C/o episodes of unconciousness altered behaviour headache

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Plain CT

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Contrast CT

Diagnosis : 

Diagnosis Multiple (Haemorrhage) Secondaries in Brain with perilesional oedema

Metastasis to Brain : 

Metastasis to Brain More than 75% of mets occur in adult pts. The age specific incidence rises steeply after the age of 45 yrs About 30% of patients with cerebral mets are asymptomatic at the time of initial diagnosis Mean survival age in patients with cerebral mets from extracranial primary malignant neoplasm is usually 3-6 months Cerebral mets occur most frequently at the junction of cortex & underlying white matter

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Enhancing Metastatic nodules at gray white junction

Metastasis to Brain : 

Metastasis to Brain 80% of brain meets occur in arterial distribution zones of cerebral hemisphere, with 3% in the basal ganglia and 15% in the cerebellum (mucinous adenoCa of GIT) On gross inspection, small mets are usually discrete, spherical, well circumscribed tumours. However microscopic examination often reveals tumour infiltration into the adjacent surrounding normal tissue Perilesional oedema is usually disproprtionate and may spread along the white matter tracts for a considerable distance

Metastasis to Brain : 

Metastasis to Brain MC source of intracranial metastasis is Ca Lung & Breast > Malignant Melanoma > Ca of kidney & GIT Bronchiogenic Ca, Ca Breast, Choriocarcinoma & melanomas have a notable propensity to metastasize to brain

Metastasis to Brain : 

Metastasis to Brain Intratumoral h’age is found in about 20% of cerebral mets, notable in melanomas, choriocarcinomas, and Ca lung, kidney and thyroid Calcification is rarely found in association with cerebral mets because of their rapid growth. However it may occasionaly found in Ca from breast & GIT Some small lesions & virtually all large mets undergo central necrosis

Metastasis to Brain : 

Metastasis to Brain Contrast enhancement is virtually universal in these tumours The double dose of contrast agent with delayed image acquisition increases the conspicuity of small tumour foci

MRI in Brain metastasis : 

MRI in Brain metastasis SI depends upon cellularity of lesion, extent of intratumoral necrosis, the presence & age of haemorrhage, the presence & extent of calcification, and the severity of surrounding oedema Melanoma (in absence of h’age)- hyper on T1 & iso on T2 Mucinous adenocarcinoma- hypo on T2 (due to high protein content of mucin)

MRI in Brain metastasis : 

MRI in Brain metastasis Contrast enhanced MR is even more sensitive in picking up the lesions Higher doses of Gd (0.2 – 0.3 mmol/kg) further improve the sensitivity Delayed MR images (unlike CT) donot increase the contrast between the tumour & the surrounding brain

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Thank You