Cystic brain metastases radiologically simulating neurocysticercosis

Troiani, Charlene; Lopes, Carla Cristina; Scardovelli, Carlos Antônio; Nai, Gisele Alborghetti

doi:10.1590/s1516-31802011000500011

Cited by 15 publications

(8 citation statements)

References 20 publications

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“…Breast cancer, adenocarcinoma of lung cancer, thymic squamous cell carcinoma metastases can be cystic/necrotic (13). Abnormally proliferating vessels of high-grade tumors have intercellular gaps and discontinuous basement membrane, causing both intravascular (flow related) and interstitial (permeability related) enhancement (1).…”

Section: Discussionmentioning

confidence: 99%

Gadolinium leakage into subarachnoid space and cystic metastases

Yıldız

Atlı²,

Oğuz³

2013

Diagn Interv Radiol

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Subarachnoid space (SAS) and cystic metastatic lesions of brain parenchyma appear hypointense on fluid-attenuated inversion-recovery (FLAIR) and T1-weighted magnetic resonance imaging (MRI) unless there is a hemorrhage or elevated protein content. Otherwise, delayed enhancement and accumulation of contrast media in SAS or cyst of metastases should be considered. We present hyperintense SAS and cystic brain metastases of lung cancer on FLAIR and T1-weighted MRI, respectively, in a patient who had been previously given contrast media for imaging of spinal metastases and had mildly impaired renal functions, and discuss the relevant literature.G adolinium (Gd) enhanced magnetic resonance imaging (MRI) is routinely performed for diagnosis and monitoring of various central nervous system diseases. On noncontrast T1-weighted imaging, most lesions are hypointense in the absence of blood products and diverse paramagnetic substances, fat or elevated protein content. Blood-brain barrier (BBB) damage and the related leakage of contrast media into the extracellular space from the vascular system result in abnormal enhancement following intravenous administration of Gd-based paramagnetic contrast materials. Therefore, numerous lesions of infectious, inflammatory, demyelinating, and malignant diseases are enhanced after contrast medium administration in the brain parenchyma (1). Gd accumulation within the cystic fluid of metastases causing a potential diagnostic misunderstanding has not been reported in the literature, to our knowledge.On normal fluid-attenuated inversion-recovery (FLAIR) imaging, the inversion-recovery pulse nulls the signal from subarachnoid space (SAS), and it is hypointense unless there is accompanying blood, tumor, inflammation or infection, as well as vascular engorgement. These conditions include subarachnoid hemorrhage, meningitis, meningeal carcinomatosis, leptomeningeal metastases, subacute infarct, subdural hematoma, adjacent neoplasms, dural venous thrombosis, and status epilepticus (2, 3). Rarely, oxygen supplementation during MRI and previous Gd-based contrast media administration may result in hyperintense SAS. Gd accumulation in SAS may occur in patients with or without renal insufficiency, and in conditions with or without BBB damage (2-5). Herein, we present a case with Gd leakage into SAS and cystic fluid of metastases with a brief review of the literature. Case reportA 48-year-old male with a metastatic lung cancer (squamous cell carcinoma) was admitted to our hospital with complaints of lower back pain and lower limb weakness for 20 days. He had received his last chemotherapy and radiotherapy treatment five months prior. On admission, neurological examination revealed lower limb paresis and paresthesia at T11-L1 dermatomes, and the patient reported urine and fecal incontinence. In laboratory tests, blood urea concentration was 23.98 mg/dL (normal range, 6-20 mg/dL), blood creatinine concentration was 1.39 mg/dL (normal range, 0.7-1.2 mg/dL), and glomerular filtration rate (GFR) wa...

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Section: Discussionmentioning

confidence: 99%

Gadolinium leakage into subarachnoid space and cystic metastases

Yıldız

Atlı²,

Oğuz³

2013

Diagn Interv Radiol

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“…Those that commonly have a cystic appearance include pilocytic astrocytoma, ganglioglioma, ependymoma, and hemangioblastoma. 3,4 Cystic brain metastases have been described from primary cancers involving the lung, breast, prostate, and pancreas. 4 Infectious etiologies include multiple abscesses, which may be from severe bacterial, mycobacterial, or fungal infections.…”

Section: Clinical Discussionmentioning

confidence: 99%

Headache and Focal Neurologic Deficits in a 37-Year-Old Woman

et al. 2013

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“…En el caso de la TC simple las lesiones son isodensas o hiperdensas (92%), pero después de la administración de contraste manifiestan reborde hiperdenso con centro hipodenso no asociados a edema vasogénico compatible con el patrón de realce en anillo 22 (Figura 1); en la RM adquiere un patrón de isointensidad o hipointensidad en T2, debido a la alta relación núcleo/ citoplasma de las células malignas 18 . Es de tener en cuenta que la presencia de una lesión única, de gran tamaño (> 3 cm) y localizada a nivel de la sustancia blanca periventricular sugiere el diagnóstico de Linfoma 12,16,23 .…”

Section: Diagnóstico Por Neuroimagenunclassified

Diagnóstico diferencial de lesiones cerebrales con realce en anillo en tomografía computarizada y resonancia magnética

Aljure

Arias

Monroy

et al. 2016

Duazary

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RESUMENLa tomografía computarizada y la resonancia magnética nuclear son técnicas imagenológicas de diagnóstico médico que ofrecen información excelente de diferentes procesos infecciosos, traumáticos o tumorales de cualquier parte del cuerpo humano. Con ellos se permitió la identificación de innumerables patologías y patrones característicos de las mismas, siendo una de ellas, el realce en anillo en el Sistema Nervioso Central. Numerosas patologías presentan este patrón imagenológico: Glioblastoma multiforme, síndromes desmielinizantes, metástasis, abscesos cerebrales, toxoplasmosis cerebral, neurocisticercosis, linfomas, entre otros. El objetivo del presente artículo es brindar una revisión general de las patologías más frecuentes en los servicios de imagenología, permitiendo su correlación con las características clínicas y brindando una ayuda al clínico que para establecer un diagnóstico adecuado. Palabras clave: Neuroimagen; Diagnóstico Diferencial; Encefalopatías ABSTRACTComputed tomography and magnetic resonance imaging are medical diagnostic imaging techniques that provide excellent information from different infectious, traumatic or tumor processes anywhere in the body. It is identifying with them many diseases and characteristic patterns of them, one of them the ring enhancement in the central nervous system allowed. Many diseases have this imaging pattern: Glioblastoma multiforme, demyelinating syndromes, metastases, brain abscesses, cerebral toxoplasmosis, neurocysticercosis, lymphomas, and others. The objective of this article is to provide an overview of the most common diseases in imaging services, allowing its correlation with clinical features and providing aid to the clinician to establish a proper diagnosis.

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Cystic brain metastases radiologically simulating neurocysticercosis

Cited by 15 publications

References 20 publications

Gadolinium leakage into subarachnoid space and cystic metastases

Gadolinium leakage into subarachnoid space and cystic metastases

Headache and Focal Neurologic Deficits in a 37-Year-Old Woman

Diagnóstico diferencial de lesiones cerebrales con realce en anillo en tomografía computarizada y resonancia magnética

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