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'''Intracerebral metastasis''' accounts for approximately 25-50% of intracranial tumors in hospitalized patients. The true incidence of brain metastasis is unknown, but recent estimates are as high as 200,000 cases per year in the United States alone. 80% of brain metastases can be accounted for by five primary tumor sites: lung, breast, skin (melanoma), kidney and the gastrointestinal tract. A population-based study of 169,444 cancer patients from 1973 to 2001 in Detroit revealed that overall, 10% of patients diagnosed with one of these five primaries went on to develop brain metastases. Specifically, 19.9% of lung cancers, 6.9% of melanomas, 6.5% of renal cancers, 5.1% of breast cancers and 1.8% of colorectal cancers metastasized to the brain.
{{SK}} Intracerebral metastasis; Brain metastasis; Brain metastases; Brain parenchymal metastasis; Brain parenchymal metastases; Cerebral metastasis; Cerebral metastases; Metastasis to brain; Metastases to brain; Metastasis to the brain; Metastases to the brain; Metastasis-Brain; Metastases-Brain; Metastatic brain tumor; Metastatic brain tumors; Metastatic brain cancer; Metastatic brain cancers; Metastatic brain neoplasm; Metastatic brain neoplasms; Secondary brain tumor; Secondary brain tumors; Secondary brain cancer; Secondary brain cancers; Secondary brain neoplasm; Secondary brain neoplasms; Intracranial metastases; Brain tumor


Parenchymal blood flow is an important determinant of the distribution of metastases. 80% of metastases localize to the cerebral hemispheres, 15% localize to the cerebellum and 3% localize to the basal ganglia. Often these tumors can be found at the gray/white matter junction.
==[[Intracerebral metastases overview|Overview]]==


==Gross appearance==
==[[Intracerebral metastases historical perspective|Historical Perspective]]==


Typically metastases are sharply demarcated from the surrounding parenchyme and usually there is a zone of peritumoral edema out of proportion with the tumor size.
==[[Intracerebral metastases classification|Classification]]==


==Microappearance==
==[[Intracerebral metastases pathophysiology|Pathophysiology]]==


Typically well-demarcated with the exception of melanoma metastases.
==[[Intracerebral metastases causes|Causes]]==


==Radiographic findings==
==[[Intracerebral metastases differential diagnosis|Differentiating Intracerebral Metastases from other Diseases]]==


There is a great deal of variability in the appearance of these tumors, however some generalizations can be made.
==[[Intracerebral metastases epidemiology and demographics|Epidemiology and Demographics]]==


===CT===
==[[Intracerebral metastases risk factors|Risk Factors]]==


'''NECT:''' Iso to hypodense mass with anywhere from zero to marked peritumoral edema.
==[[Intracerebral metastases screening|Screening]]==


'''CECT:''' enhancement is also variable and can be intense, punctuate, nodular or ring-enhanced if the tumour has out grown it's blood supply.
==[[Intracerebral metastases natural history, complications and prognosis|Natural History, Complications and Prognosis]]==


===MRI===
==Diagnosis==
 
[[Subependymal giant cell astrocytoma staging|Staging]] | [[Intracerebral metastases history and symptoms|History and Symptoms]] | [[Intracerebral metastases physical examination|Physical Examination]] | [[Intracerebral metastases laboratory findings|Laboratory Findings]] | [[Intracerebral metastases chest x ray|Chest X Ray]] | [[Intracerebral metastases CT|CT]] | [[Intracerebral metastases MRI|MRI]] | [[Intracerebral metastases ultrasound|Ultrasound]] | [[Intracerebral metastases other imaging findings|Other Imaging Findings]] | [[Intracerebral metastases other diagnostic studies|Other Diagnostic Studies]]
'''T1W:''' Typically iso to hypointense mass, however melanoma metastases are an exception to this rule (hyperintense due to the paramagnetic properties of melanin).
 
'''T2W:''' Typically hyperintense. If metastases are scattered the pattern may mimic vascular disease.
 
'''FLAIR:''' Typically hyperintense with hyperintense peritumoral edema.
 
'''T1 C+:''' The enhancement pattern can be uniform, punctuate, or ring-enhanced, but it is usually intense.  Delayed sequences may show additional lesions, therefore contrast-enhance MR is the current standard for small met detection.
 
'''MRS:''' Intratumoral choline peak with no choline elevation in the peritumoral edema.  Any tumor necrosis results in a lipid peak.
 
'''DWI:''' edema is out of proportion with tumour size and appears dark on trace-weighted DWI.
Nuclear medicine
 
'''FDG PET:''' Generally considered the best imaging tool for metastases.  However it can only detect metastases up to 1.5 cm in size, therefore CEMR is the gold standard to rule out small mets. Lung, breast, colorectal, head and neck, melanoma and thyroid mets are usually hypermetabolic. Mucinous adenocarcinoma and RCC are typically hypometabolic and gliomas and lymphomas are variable. Any central hypometabolism indicates necrosis.
 
==Clinical presentation and prognosis==
 
These patients commonly present with headache, seizure, mental status changes, ataxia, nausea and vomiting and visual disturbances.  However, 10% of these patients may be asymptomatic.
 
Patients with brain mets have a mean survival of one month without treatment.  With treatment, survival improves, but it is still dismal.  The mean age of survival is still less than one year.
 
==Differential Diagnosis==
 
* Abscess: typically hypermetabolic with central hypometabolism signifying necrosis
* CVA
* Primary brain neoplasm
* Meningioma
* Post-treatment effects (post-surgical or post radiation): hypermetabolic acutely progressing to hypometabolic over time
* Epilepsy
 
===Image Gallery for Differential Diagnosis===
 
<gallery>
Image:Melanoma met.jpg|Melanoma met
Image:Bull's eye met.jpg|Bull's eye met
</gallery>


==Treatment==
==Treatment==


'''Symptomatic:''' Corticosteroids are given to limit the effects of peritumoral edema. Hyperosmolar agents (eg mannitol) can be given to decrease ICP and anticonvulsants are given to prevent seizures. Recently, methylphenidate and donepezil have been used to improve cognition, mood and quality of life.
[[Intracerebral metastases medical therapy|Medical Therapy]] | [[Intracerebral metastases surgery|Surgery]] | [[Intracerebral metastases primary prevention|Primary Prevention]] | [[Intracerebral metastases secondary prevention|Secondary Prevention]] | [[Intracerebral metastases cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Intracerebral metastases future or investigational therapies|Future or Investigational Therapies]]
 
'''Therapeutic:''' Radiation (whole brain external beam or stereotactic for smaller masses), chemotherapy and surgical resection are done to prolong survival and palliate symptoms. Other than germ cell tumours, leukemias and lymphomas, palliation is the rule and curative therapy is the subject of case reports.
 
 


{{SIB}}
==Case Studies==
[[Intracerebral metastases case study one|Case #1]]


[[Category:Disease]]
[[Category:Neurology]]
[[Category:Oncology]]
[[Category:Oncology]]


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Latest revision as of 20:33, 23 November 2015

Intracerebral metastases Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Intracerebral Metastases from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Staging

History and Symptoms

Physical Examination

Laboratory Findings

Chest X Ray

CT

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Intracerebral metastases On the Web

Most recent articles

Most cited articles

Review articles

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Powerpoint slides

Images

American Roentgen Ray Society Images of Intracerebral metastases

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Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Intracerebral metastases

CDC on Intracerebral metastases

Intracerebral metastases in the news

Blogs on Intracerebral metastases

Directions to Hospitals Treating Intracerebral metastases

Risk calculators and risk factors for Intracerebral metastases

For patient information, click here.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor in Editor: Cafer Zorkun, M.D., Ph.D. [2], Sujit Routray, M.D. [3]

Synonyms and keywords: Intracerebral metastasis; Brain metastasis; Brain metastases; Brain parenchymal metastasis; Brain parenchymal metastases; Cerebral metastasis; Cerebral metastases; Metastasis to brain; Metastases to brain; Metastasis to the brain; Metastases to the brain; Metastasis-Brain; Metastases-Brain; Metastatic brain tumor; Metastatic brain tumors; Metastatic brain cancer; Metastatic brain cancers; Metastatic brain neoplasm; Metastatic brain neoplasms; Secondary brain tumor; Secondary brain tumors; Secondary brain cancer; Secondary brain cancers; Secondary brain neoplasm; Secondary brain neoplasms; Intracranial metastases; Brain tumor

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Intracerebral Metastases from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Staging | History and Symptoms | Physical Examination | Laboratory Findings | Chest X Ray | CT | MRI | Ultrasound | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1


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