Neuroimaging of Parenchymal Brain Metastases

Walker, Matthew T.; Kapoor, Vipul

doi:10.1007/978-0-387-69222-7_3

Cited by 15 publications

(8 citation statements)

References 30 publications

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“…Thus, contrast-enhanced (CE) imaging methods (1)(2)(3)(4)(5)(6), which are sensitive to the T 1 -shortening effect of contrast materials, have been used for the detection of brain metastases. Among them, CE T 1 -weighted two-dimensional spin echo (SE) imaging has gained widespread clinical acceptance for the detection of brain tumors with permeable vessels, providing high signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR), but has limitations in detecting the small size of metastases due to partial-volume effects.…”

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confidence: 99%

Contrast-enhanced, three-dimensional, whole-brain, black-blood imaging: Application to small brain metastases

Park

Kim

2010

Magn. Reson. Med.

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Contrast-enhanced three-dimensional T 1 -weighted imaging based on magnetization-prepared rapid-gradient recalled echo is widely used for detecting small brain metastases. However, since contrast materials remain in both blood and the tumor parenchyma and thus increase the signal intensity of both regions, it is often challenging to distinguish brain tumors from blood. In this work, we develop a T 1 -weighted, black-blood version of single-slab three-dimensional turbo/ fast spin echo whole-brain imaging, in which the signal intensity of the brain tumor is selectively enhanced while that of blood is suppressed. For blood suppression, variable refocusing flip angles with flow-sensitizing gradients are employed. To avoid a signal loss resulting from the flow-sensitizing scheme, the first refocusing flip angle is forced to 180°. Composite restore pulses at the end of refocusing pulse train are applied to achieve partial inversion recovery for the T 1 -weighted contrast. Simulations and in vivo volunteer and patient experiments are performed, demonstrating that this approach is highly efficient in detecting small brain metastases. Magn Reson Med 63:553-561, 2010. V C 2010 Wiley-Liss, Inc.Key words: contrast-enhanced; metastatic tumor; black blood; magnetic resonance imaging; MRI; three dimensional; variable flip angle In brain metastasis, wherein blood vessels do not maintain the blood-brain barrier, exogenously administered small-molecular-weight contrast agents typically accumulate within the extravascular extracellular space. Thus, contrast-enhanced (CE) imaging methods (1-6), which are sensitive to the T 1 -shortening effect of contrast materials, have been used for the detection of brain metastases. Among them, CE T 1 -weighted two-dimensional spin echo (SE) imaging has gained widespread clinical acceptance for the detection of brain tumors with permeable vessels, providing high signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR), but has limitations in detecting the small size of metastases due to partial-volume effects. To overcome this problem, magnetizationprepared rapid-gradient-echo (MP-RAGE) imaging (7,8), which is the most widely used three-dimensional (3D) T 1 -weighted imaging sequence, can be used to acquire high-resolution, isotropic whole-brain data in a clinically acceptable imaging time. Despite these advantages, a potential confound is the distribution of contrast agents within blood vessels and the tumor parenchyma resulting in the simultaneous enhancement of both regions, thereby impairing the accuracy of metastatic lesion detection. Thus, since the blood vessels close to the brain tumors may result in diagnostic confusion, it is necessary to selectively enhance the signal intensity of the brain tumors while suppressing the blood vessels elsewhere in the brain.Black-blood imaging methods (9-14), wherein blood signals are selectively suppressed using spatial presaturation (9,10), double inversion recovery (11,12), or motion-sensitizing magnetization preparation (13,14), if successfully...

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Contrast-enhanced, three-dimensional, whole-brain, black-blood imaging: Application to small brain metastases

Park

Kim

2010

Magn. Reson. Med.

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“…Depending on the histological origin, cerebral metastases can present with varying attenuation on noncontrast CT (17). A majority of metastasis are hypo to isodense when compared to adjacent brain parenchyma (Figure 5).…”

Section: Imaging Findings and Pathologymentioning

confidence: 99%

“…Following the administration of contrast media most parenchymal metastases avidly enhance due to the lack of neurovascular unit (17). Two predominant patterns of enhancement include solid nodular and ring enhancing with nodular components (Figure 4–6 and 14–15).…”

Section: Imaging Findings and Pathologymentioning

confidence: 99%

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Metastasis in Adult Brain Tumors

Barajas

2016

Neuroimaging Clinics of North America

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SYNOPSIS Metastatic cancer to the CNS is primarly deposited by hematogenous spread in various anatomically distinct regions; calvarial, pachymeningeal, leptomeningeal, and brain parenchyma. A patients overall clinical status and the information needed to make treatment decisions are the primary considerations in initial imaging modality selection. Contrast enhanced MR imaging is the preferred imaging modality, however, CT is often utilized for first pass screening of life threating metastatic complications. Morphologic MR imaging such as T1 and T2 weighted sequences are limited to delineating anatomical deraignment of tissues. DSC perfusion and diffusion weighted physiology based MR imaging sequences have been developed which compliment morphologic MR imaging by providing additional diagnostic information that allows for improved tumor characterization. Common pitfalls in evaluating for metastatic disease include the misidentification of non-neoplastic hematomas, remote microvascular ischemia, and acute onset of ischemic stroke.

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“…[3461100] The incidence rate of all forms of brain metastasis in the United States is approximately 170,000 per year. [52] It is estimated that 20–40% of all cancer patients develop some form of intracranial metastases.…”

Section: Introductionmentioning

confidence: 99%

Solitary cerebral metastasis from transitional cell carcinoma after a 14-year remission of urinary bladder cancer treated with gemcitabine: Case report and literature review

Jm¹,

Ms²,

Z³

et al. 2012

Surg Neurol Int

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Background:Brain metastases are the most common adult brain tumors, frequently arising from primary tumors in the lung, breast, skin, kidneys, and colon. Transitional cell carcinoma (TCC), the most common type of urinary bladder cancer, is a rare cause of brain metastasis with an ominous prognosis.Case Description:A 68-year-old female presented with right-sided paresis and focal motor seizures of her right upper and lower extremities 14 years after being diagnosed and treated for primary TCC of the urinary bladder with gemcitabine-based chemotherapy. MRI imaging revealed a 3.1 × 3.1 × 2.7 cm heterogeneously enhancing mass located along the posterior aspect of the left frontal convexity. The lesion was accessed using a transsulcal approach and was surgically debulked along the motor cortex with motor strip mapping, followed by adjuvant whole-brain radiation therapy. Pathological examination confirmed metastatic carcinoma with features of TCC, a rare entity among metastatic brain tumors.Conclusion:Brain metastases may present several years later in patients with TCC of the urinary bladder who have been treated with surgery and chemotherapy. Chemotherapeutic agents that penetrate the blood–brain barrier, such as gemcitabine, may delay development of cerebral metastasis from primary TCC of the urinary bladder.

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Neuroimaging of Parenchymal Brain Metastases

Cited by 15 publications

References 30 publications

Contrast-enhanced, three-dimensional, whole-brain, black-blood imaging: Application to small brain metastases

Contrast-enhanced, three-dimensional, whole-brain, black-blood imaging: Application to small brain metastases

Metastasis in Adult Brain Tumors

Solitary cerebral metastasis from transitional cell carcinoma after a 14-year remission of urinary bladder cancer treated with gemcitabine: Case report and literature review

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