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
Slide 2: Plain CT
Slide 3: 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
Slide 6: 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
Slide 15: Thank You