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==Overview==
==Overview==
Head CT scan may be helpful in the diagnosis of intracerebral metastases. On CT scan, intracerebral metastases are characterized by iso- to hypodense mass with zero to marked peritumoral [[edema]]. On contrast administration, variable enhancement (intense, punctuate, nodular, or ring-enhanced) may be present.<ref name=ctfindingsbrainmets1>Radiographic CT features of brain metastasis. Dr Bruno Di Muzio and Dr Trent Orton et al. Radiopaedia 2015. http://radiopaedia.org/articles/brain-metastases. accessed on November 13, 2015</ref>


==CT==
==CT==
'''NECT:''' Iso to hypodense mass with anywhere from zero to marked peritumoral edema.
*Head CT scan may be helpful in the diagnosis of intracerebral metastases.<ref name=ctfindingsbrainmets1>Radiographic CT features of brain metastasis. Dr Bruno Di Muzio and Dr Trent Orton et al. Radiopaedia 2015. http://radiopaedia.org/articles/brain-metastases. accessed on November 13, 2015</ref>
*Findings on CT scan suggestive of intracerebral metastases include:<ref name=ctfindingsbrainmets1>Radiographic CT features of brain metastasis. Dr Bruno Di Muzio and Dr Trent Orton et al. Radiopaedia 2015. http://radiopaedia.org/articles/brain-metastases. accessed on November 13, 2015</ref>
:*'''Non-enhanced CT (NECT)''': Iso- to hypodense mass with zero to marked peritumoral [[edema]]
:*'''Contrast-enhanced CT (CECT)''': Enhancement is also variable (intense, punctuate, nodular, or ring-enhanced) if the tumor has outgrown it's blood supply


'''CECT:''' enhancement is also variable and can be intense, punctuate, nodular or ring-enhanced if the tumour has out grown it's blood supply.
==Gallery==
<gallery>
Image:BrainMetastasisFromBreastCancer.jpg|<sub>CT scan of head before (left image) and after (right image) injection of iodinated contrast of a 75 year old patient demonstrating three brain metastatic masses from breast cancer with large peripheral edema.<ref name=CTscanbrainmet1>Media in category "Brain metastasis". Wikimedia commons 2015. https://commons.wikimedia.org/wiki/Category:Brain_metastasis. Accessed on November 10, 2015</ref></sub>
Image:CT scan of brain metastasis 1.jpg|<sub>CT scan of a 60 year old patient who developed left-handed weakness which improved with corticosteroids and neurological examination revealing left pronator drift and left sided arm and leg weakness demonstrates right frontoparietal hyperdense intra-axial lesion that enhances in post contrast study. Small surrounding vasogenic edema and no significant mass effect is observed.<ref name=CTimage1>Image courtesy of Dr. Frank Gaillard. Radiopaedia (original file [http://radiopaedia.org/cases/metastatic-malignant-melanoma here]). Creative Commons BY-SA-NC</ref></sub>
Image:CT scan of brain metastasis 2.jpg|<sub>CT scan of a patient with known (histologically confirmed) small cell carcinoma of the lungs demonstrates multiple cystic cerebral metastases.<ref name=ctimage2>Image courtesy of Dr. Frank Gaillard. Radiopaedia (original file [http://radiopaedia.org/cases/cerebral-metastases-1 here]). Creative Commons BY-SA-NC</ref></sub>
Image:CT scan of brain metastasis 3.jpg|<sub>Ct scan without contrast of the patient with known metastatic breast cancer, complaining of headache, demonstrates a solitary right frontal lobe mass with extensive surrounding edema. The mass has it's epicenter close to the grey white matter junction.<ref name=ctimage3>Image courtesy of Dr. Frank Gaillard. Radiopaedia (original file [http://radiopaedia.org/cases/cerebral-metastasis-breast-cancer here]). Creative Commons BY-SA-NC</ref></sub>
Image:CT scan of brain metastasis 4.jpg|<sub>Ct scan with contrast of the patient with known metastatic breast cancer, complaining of headache, demonstrates a solitary heterogenously enhancing right frontal lobe mass with extensive surrounding edema. The mass has it's epicenter close to the grey white matter junction.<ref name=ctimage3>Image courtesy of Dr. Frank Gaillard. Radiopaedia (original file [http://radiopaedia.org/cases/cerebral-metastasis-breast-cancer here]). Creative Commons BY-SA-NC</ref></sub>
Image:CT scan of brain metastasis 5.jpg|<sub>Postcontrast CT image of brain for a 60 year old male patient with metastatic bronchogenic carcinoma presenting with altered mental status and headache of recent onset demonstrating enhancing intra-axial lesion.<ref name=ctimage5>Image courtesy of Dr. Hani Al Salam. Radiopaedia (original file [http://radiopaedia.org/cases/bronchogenic-carcinoma-metastasis here]). Creative Commons BY-SA-NC</ref></sub>
Image:CT scan of brain metastasis 6 noncontrast.jpg|<sub>Noncontrast CT of a 36 year old female, a known case of esophageal cancer, presenting with headache and right sided hemiparesis, demonstrates a cystic lesion (37 x 31 mm) in the left high frontal lobe with significant perilesionalvasogenic edema causing mass effect in the form of sulcal effacement and subfalcine herniation.<ref name=ctimage6>Image courtesy of Dr. Ayush Goel. Radiopaedia (original file [http://radiopaedia.org/cases/cystic-cerebral-metastases here]). Creative Commons BY-SA-NC</ref></sub>
Image:CT scan of brain metastasis 7 postcontrast.jpg|<sub>Post contrast CT of a 36 year old female, a known case of esophageal cancer, presenting with headache and right sided hemiparesis, demonstrates a ring-enhancing cystic lesion (37 x 31 mm) in the left high frontal lobe with significant perilesionalvasogenic edema causing mass effect in the form of sulcal effacement and subfalcine herniation.<ref name=ctimage6>Image courtesy of Dr. Ayush Goel. Radiopaedia (original file [http://radiopaedia.org/cases/cystic-cerebral-metastases here]). Creative Commons BY-SA-NC</ref></sub>
Image:CT scan of brain metastasis 8.jpg|<sub>Noncontrast CT scan of a 70 year old female with a known history of metastatic colorectal cancer, presenting with right sided hemiparesis, demonstrates a 2cm rounded mass is present in the post-central gyrus, which is iso-dense to cortex pre-contrast and demonstrates homogeneous contrast enhancement. It is located at the grey-white matter interface and is surrounded by extensive vasogenic edema, which exerts significant mass effect.<ref name=ctimage8>Image courtesy of Dr. Frank Gaillard. Radiopaedia (original file [http://radiopaedia.org/cases/cerebral-metastasis-solitary here]). Creative Commons BY-SA-NC</ref></sub>
Image:CT scan of brain metastasis 9.jpg|<sub>Following the administration of contrast, the mass demonstrates relatively vivid enhancement. It remains an isolated abnormality.<ref name=ctimage8>Image courtesy of Dr. Frank Gaillard. Radiopaedia (original file [http://radiopaedia.org/cases/cerebral-metastasis-solitary here]). Creative Commons BY-SA-NC</ref></sub>
Image:CT scan of brain metastasis 10.jpg|<sub>Noncontrast CT scan of a 53 year old caucasian male with known history of malignant melanoma, complaining of headaches, demonstrates hyperdense lesions in brain.<ref name=ctimage10>Image courtesy of Dr. Bruno Di Muzio. Radiopaedia (original file [http://radiopaedia.org/cases/metastatic-melanoma-in-the-brain here]). Creative Commons BY-SA-NC</ref></sub>
Image:CT scan of brain metastasis 11.jpg|<sub>Noncontrast CT scan of a 80 year old hispanic female with known history of lung cancer, presenting with impaired consciousness, demonstrates several hypodense area of vasogenic edema in the right frontal lobe with two scattered rounded dense images.<ref name=ctimage11>Image courtesy of Dr. David Cuete. Radiopaedia (original file [http://radiopaedia.org/cases/haemorrhagic-brain-metastases here]). Creative Commons BY-SA-NC</ref></sub>
Image:CT scan of brain metastasis 12.jpg|<sub>Contrast CT scan of a 80 year old hispanic female with known history of lung cancer, presenting with impaired consciousness, demonstrates an enhanced mass in the right frontal hemisphere.<ref name=ctimage11>Image courtesy of Dr. David Cuete. Radiopaedia (original file [http://radiopaedia.org/cases/haemorrhagic-brain-metastases here]). Creative Commons BY-SA-NC</ref></sub>
Image:CT scan of brain metastasis 13.jpg|<sub>Contrast CT scan of a 60 year old hispanic female with known history of metastatic breast cancer demonstrates two round lesions with ring-shaped enhancement in the right temporal region with perilesional edema.<ref name=ctimage13>Image courtesy of Dr. David Cuete. Radiopaedia (original file [http://radiopaedia.org/cases/brain-metastases-from-breast-cancer here]). Creative Commons BY-SA-NC</ref></sub>
Image:CT scan of brain metastasis 14.jpg|<sub>Contrast CT scan of a 85 year olf male with metastatic renal cell carcinoma, complaining of recent-onset headache, demonstrates a well-defined, vividly contrast enhancing mass identified in the right frontal lobe measuring 25 x 20 x 18 mm. The mass demonstrates a thick contrast-enhancing rim and a 6 x 6 mm focus of central hypodensity/necrosis. There is extensive surrounding vasogenic edema resulting in mass-effect with sulcal effacement, effacement of the right lateral ventricle, and 3 mm left-sided midline shift. No other mass, focal abnormality, intra or extra-axial collection is identified. Ventricles and basal cisterns are within normal limits and age appropriate.<ref name=ctimage14>Image courtesy of Dr. Frank Gaillard. Radiopaedia (original file [http://radiopaedia.org/cases/cerebral-metastasis here]). Creative Commons BY-SA-NC</ref></sub>
 
</gallery>


==References==
==References==
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Latest revision as of 16:30, 17 November 2015

Intracerebral metastases Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sujit Routray, M.D. [2]

Overview

Head CT scan may be helpful in the diagnosis of intracerebral metastases. On CT scan, intracerebral metastases are characterized by iso- to hypodense mass with zero to marked peritumoral edema. On contrast administration, variable enhancement (intense, punctuate, nodular, or ring-enhanced) may be present.[1]

CT

  • Head CT scan may be helpful in the diagnosis of intracerebral metastases.[1]
  • Findings on CT scan suggestive of intracerebral metastases include:[1]
  • Non-enhanced CT (NECT): Iso- to hypodense mass with zero to marked peritumoral edema
  • Contrast-enhanced CT (CECT): Enhancement is also variable (intense, punctuate, nodular, or ring-enhanced) if the tumor has outgrown it's blood supply

Gallery

  • CT scan of head before (left image) and after (right image) injection of iodinated contrast of a 75 year old patient demonstrating three brain metastatic masses from breast cancer with large peripheral edema.[2]

    CT scan of head before (left image) and after (right image) injection of iodinated contrast of a 75 year old patient demonstrating three brain metastatic masses from breast cancer with large peripheral edema.[2]

  • CT scan of a 60 year old patient who developed left-handed weakness which improved with corticosteroids and neurological examination revealing left pronator drift and left sided arm and leg weakness demonstrates right frontoparietal hyperdense intra-axial lesion that enhances in post contrast study. Small surrounding vasogenic edema and no significant mass effect is observed.[3]

    CT scan of a 60 year old patient who developed left-handed weakness which improved with corticosteroids and neurological examination revealing left pronator drift and left sided arm and leg weakness demonstrates right frontoparietal hyperdense intra-axial lesion that enhances in post contrast study. Small surrounding vasogenic edema and no significant mass effect is observed.[3]

  • CT scan of a patient with known (histologically confirmed) small cell carcinoma of the lungs demonstrates multiple cystic cerebral metastases.[4]

    CT scan of a patient with known (histologically confirmed) small cell carcinoma of the lungs demonstrates multiple cystic cerebral metastases.[4]

  • Ct scan without contrast of the patient with known metastatic breast cancer, complaining of headache, demonstrates a solitary right frontal lobe mass with extensive surrounding edema. The mass has it's epicenter close to the grey white matter junction.[5]

    Ct scan without contrast of the patient with known metastatic breast cancer, complaining of headache, demonstrates a solitary right frontal lobe mass with extensive surrounding edema. The mass has it's epicenter close to the grey white matter junction.[5]

  • Ct scan with contrast of the patient with known metastatic breast cancer, complaining of headache, demonstrates a solitary heterogenously enhancing right frontal lobe mass with extensive surrounding edema. The mass has it's epicenter close to the grey white matter junction.[5]

    Ct scan with contrast of the patient with known metastatic breast cancer, complaining of headache, demonstrates a solitary heterogenously enhancing right frontal lobe mass with extensive surrounding edema. The mass has it's epicenter close to the grey white matter junction.[5]

  • Postcontrast CT image of brain for a 60 year old male patient with metastatic bronchogenic carcinoma presenting with altered mental status and headache of recent onset demonstrating enhancing intra-axial lesion.[6]

    Postcontrast CT image of brain for a 60 year old male patient with metastatic bronchogenic carcinoma presenting with altered mental status and headache of recent onset demonstrating enhancing intra-axial lesion.[6]

  • Noncontrast CT of a 36 year old female, a known case of esophageal cancer, presenting with headache and right sided hemiparesis, demonstrates a cystic lesion (37 x 31 mm) in the left high frontal lobe with significant perilesionalvasogenic edema causing mass effect in the form of sulcal effacement and subfalcine herniation.[7]

    Noncontrast CT of a 36 year old female, a known case of esophageal cancer, presenting with headache and right sided hemiparesis, demonstrates a cystic lesion (37 x 31 mm) in the left high frontal lobe with significant perilesionalvasogenic edema causing mass effect in the form of sulcal effacement and subfalcine herniation.[7]

  • Post contrast CT of a 36 year old female, a known case of esophageal cancer, presenting with headache and right sided hemiparesis, demonstrates a ring-enhancing cystic lesion (37 x 31 mm) in the left high frontal lobe with significant perilesionalvasogenic edema causing mass effect in the form of sulcal effacement and subfalcine herniation.[7]

    Post contrast CT of a 36 year old female, a known case of esophageal cancer, presenting with headache and right sided hemiparesis, demonstrates a ring-enhancing cystic lesion (37 x 31 mm) in the left high frontal lobe with significant perilesionalvasogenic edema causing mass effect in the form of sulcal effacement and subfalcine herniation.[7]

  • Noncontrast CT scan of a 70 year old female with a known history of metastatic colorectal cancer, presenting with right sided hemiparesis, demonstrates a 2cm rounded mass is present in the post-central gyrus, which is iso-dense to cortex pre-contrast and demonstrates homogeneous contrast enhancement. It is located at the grey-white matter interface and is surrounded by extensive vasogenic edema, which exerts significant mass effect.[8]

    Noncontrast CT scan of a 70 year old female with a known history of metastatic colorectal cancer, presenting with right sided hemiparesis, demonstrates a 2cm rounded mass is present in the post-central gyrus, which is iso-dense to cortex pre-contrast and demonstrates homogeneous contrast enhancement. It is located at the grey-white matter interface and is surrounded by extensive vasogenic edema, which exerts significant mass effect.[8]

  • Following the administration of contrast, the mass demonstrates relatively vivid enhancement. It remains an isolated abnormality.[8]

    Following the administration of contrast, the mass demonstrates relatively vivid enhancement. It remains an isolated abnormality.[8]

  • Noncontrast CT scan of a 53 year old caucasian male with known history of malignant melanoma, complaining of headaches, demonstrates hyperdense lesions in brain.[9]

    Noncontrast CT scan of a 53 year old caucasian male with known history of malignant melanoma, complaining of headaches, demonstrates hyperdense lesions in brain.[9]

  • Noncontrast CT scan of a 80 year old hispanic female with known history of lung cancer, presenting with impaired consciousness, demonstrates several hypodense area of vasogenic edema in the right frontal lobe with two scattered rounded dense images.[10]

    Noncontrast CT scan of a 80 year old hispanic female with known history of lung cancer, presenting with impaired consciousness, demonstrates several hypodense area of vasogenic edema in the right frontal lobe with two scattered rounded dense images.[10]

  • Contrast CT scan of a 80 year old hispanic female with known history of lung cancer, presenting with impaired consciousness, demonstrates an enhanced mass in the right frontal hemisphere.[10]

    Contrast CT scan of a 80 year old hispanic female with known history of lung cancer, presenting with impaired consciousness, demonstrates an enhanced mass in the right frontal hemisphere.[10]

  • Contrast CT scan of a 60 year old hispanic female with known history of metastatic breast cancer demonstrates two round lesions with ring-shaped enhancement in the right temporal region with perilesional edema.[11]

    Contrast CT scan of a 60 year old hispanic female with known history of metastatic breast cancer demonstrates two round lesions with ring-shaped enhancement in the right temporal region with perilesional edema.[11]

  • Contrast CT scan of a 85 year olf male with metastatic renal cell carcinoma, complaining of recent-onset headache, demonstrates a well-defined, vividly contrast enhancing mass identified in the right frontal lobe measuring 25 x 20 x 18 mm. The mass demonstrates a thick contrast-enhancing rim and a 6 x 6 mm focus of central hypodensity/necrosis. There is extensive surrounding vasogenic edema resulting in mass-effect with sulcal effacement, effacement of the right lateral ventricle, and 3 mm left-sided midline shift. No other mass, focal abnormality, intra or extra-axial collection is identified. Ventricles and basal cisterns are within normal limits and age appropriate.[12]

    Contrast CT scan of a 85 year olf male with metastatic renal cell carcinoma, complaining of recent-onset headache, demonstrates a well-defined, vividly contrast enhancing mass identified in the right frontal lobe measuring 25 x 20 x 18 mm. The mass demonstrates a thick contrast-enhancing rim and a 6 x 6 mm focus of central hypodensity/necrosis. There is extensive surrounding vasogenic edema resulting in mass-effect with sulcal effacement, effacement of the right lateral ventricle, and 3 mm left-sided midline shift. No other mass, focal abnormality, intra or extra-axial collection is identified. Ventricles and basal cisterns are within normal limits and age appropriate.[12]

References

  1. ↑ 1.0 1.1 1.2 Radiographic CT features of brain metastasis. Dr Bruno Di Muzio and Dr Trent Orton et al. Radiopaedia 2015. http://radiopaedia.org/articles/brain-metastases. accessed on November 13, 2015
  2. ↑ Media in category "Brain metastasis". Wikimedia commons 2015. https://commons.wikimedia.org/wiki/Category:Brain_metastasis. Accessed on November 10, 2015
  3. ↑ Image courtesy of Dr. Frank Gaillard. Radiopaedia (original file here). Creative Commons BY-SA-NC
  4. ↑ Image courtesy of Dr. Frank Gaillard. Radiopaedia (original file here). Creative Commons BY-SA-NC
  5. ↑ 5.0 5.1 Image courtesy of Dr. Frank Gaillard. Radiopaedia (original file here). Creative Commons BY-SA-NC
  6. ↑ Image courtesy of Dr. Hani Al Salam. Radiopaedia (original file here). Creative Commons BY-SA-NC
  7. ↑ 7.0 7.1 Image courtesy of Dr. Ayush Goel. Radiopaedia (original file here). Creative Commons BY-SA-NC
  8. ↑ 8.0 8.1 Image courtesy of Dr. Frank Gaillard. Radiopaedia (original file here). Creative Commons BY-SA-NC
  9. ↑ Image courtesy of Dr. Bruno Di Muzio. Radiopaedia (original file here). Creative Commons BY-SA-NC
  10. ↑ 10.0 10.1 Image courtesy of Dr. David Cuete. Radiopaedia (original file here). Creative Commons BY-SA-NC
  11. ↑ Image courtesy of Dr. David Cuete. Radiopaedia (original file here). Creative Commons BY-SA-NC
  12. ↑ Image courtesy of Dr. Frank Gaillard. Radiopaedia (original file here). Creative Commons BY-SA-NC


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