Abstract:Although metastases found during head magnetic resonance imaging (MRI) are not limited to metastatic brain tumors, the MRI is a very common method for “brain metastasis screening,” a modality that is being increasingly performed. In this review, we describe MRI findings of nonbrain metastases and discuss ways to avoid missing these lesions. Metastatic cranial bone tumors are among the most common nonbrain metastatic lesions found on head MRI, followed by leptomeningeal carcinomatosis. The other less-frequent m… Show more
“…Contrast enhancement tends to be avid, and flow voids can be observed within the lesion [ 52 ]. However, it is often challenging to diagnose a pituitary metastasis without other metastatic lesions or bone destruction on the first surveillance MRI of the brain [ 54 ]. Fig.…”
Hypophysitis is an inflammatory disease affecting the pituitary gland. Hypophysitis can be classified into multiple types depending on the mechanisms (primary or secondary), histology (lymphocytic, granulomatous, xanthomatous, plasmacytic/IgG4 related, necrotizing, or mixed), and anatomy (adenohypophysitis, infundibulo-neurohypophysitis, or panhypophysitis). An appropriate diagnosis is vital for managing these potentially life-threatening conditions. However, physiological morphological alterations, remnants, and neoplastic and non-neoplastic lesions may masquerade as hypophysitis, both clinically and radiologically. Neuroimaging, as well as imaging findings of other sites of the body, plays a pivotal role in diagnosis. In this article, we will review the types of hypophysitis and summarize clinical and imaging features of both hypophysitis and its mimickers.
“…Contrast enhancement tends to be avid, and flow voids can be observed within the lesion [ 52 ]. However, it is often challenging to diagnose a pituitary metastasis without other metastatic lesions or bone destruction on the first surveillance MRI of the brain [ 54 ]. Fig.…”
Hypophysitis is an inflammatory disease affecting the pituitary gland. Hypophysitis can be classified into multiple types depending on the mechanisms (primary or secondary), histology (lymphocytic, granulomatous, xanthomatous, plasmacytic/IgG4 related, necrotizing, or mixed), and anatomy (adenohypophysitis, infundibulo-neurohypophysitis, or panhypophysitis). An appropriate diagnosis is vital for managing these potentially life-threatening conditions. However, physiological morphological alterations, remnants, and neoplastic and non-neoplastic lesions may masquerade as hypophysitis, both clinically and radiologically. Neuroimaging, as well as imaging findings of other sites of the body, plays a pivotal role in diagnosis. In this article, we will review the types of hypophysitis and summarize clinical and imaging features of both hypophysitis and its mimickers.
Differential diagnosis of metastatic brain tumor, carcinomatous meningitis, and paraneoplastic neurological syndrome (PNS) can be challenging in atypical cases. When examining patient with increased T2 fluid-attenuated inversion recovery (FLAIR) hyperintensities in the temporal polar white matter, autoimmune encephalitis, including PNS, should be considered. Herein, we report the case of an 85-year-old man with carcinomatous meningitis due to lung large cell carcinoma. He showed disturbance of consciousness, abnormal behavior, incomprehensible speech, and apathy, which suggested brain dysfunction. Magnetic resonance imaging revealed high intensities on the whole cerebellum on a diffusion-weighted image and bilateral T2 FLAIR hyperintensities in the temporal polar white matter. Cerebrospinal fluid analysis and cytology showed elevated total protein levels, pleocytosis, and atypical cells with nuclear enlargement, hyperchromasia, and irregular shape. Autopsy revealed lung large cell carcinoma and its brain metastasis. Tumor cells were disseminated to the central nervous system along the subarachnoid space. Furthermore, plenty of carcinoma cells and peritumoral enlarged perivascular space were observed in the temporal poles. To our knowledge, this is the first report of bilateral T2 FLAIR hyperintensities in the temporal polar white matter caused by carcinomatous meningitis with pathological confirmation. In patient with carcinomatous meningitis, abnormal T2 FLAIR hyperintensities may not be derived from ischemia or tumor invasion to parenchyma.
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