Fact-sheet: Metastasis to brain


Updated on 08/26/2020 at 2:25 PM

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Definition

Brain metastases are the most common intracranial tumors, particularly in the posterior fossa.

The most common primary tumors are:
- bronchogenic carcinoma
- breast carcinoma
- renal cell carcinoma
- gastrointestinal tract tumor
- malignant melanoma
- choriocarcinoma. Urologic

cancers are not the leading source of metastases; however, renal and testicular cancers should be kept in mind.

Clinical features

  • Seizure.
  • Intracranial hypertension.
  • Sensorimotor neurologic deficit.

CT

Lesions hypodense or isodense to the adjacent parenchyma.
After contrast administration, homogeneous enhancement.
Hypodense perilesional edema.

Mass effect (displacement of adjacent structures and effacement of sulci).

Metastases may show particular patterns: nodular, cystic, hemorrhagic, or calcified forms, with dural extension.

MRI

Reference examination Classic appearance:

  • T1: iso- or hypointense to the adjacent parenchyma, perilesional edema in hyperintensity.
  • T2 or T2-FLAIR: hyperintensity of the lesion, hyperintensity of the perilesional edema.
  • After gadolinium administration: homogeneous enhancement, sometimes peripheral.
  • Diffusion: the cystic component is often hypointense on b1000.
  • Perfusion: increased rCBV reflecting neoangiogenesis, hyperintense on FLAIR and T2.
  • Spectroscopy: frequent increase in the choline peak and choline/creatine ratio, with lipid and lactate peaks in cases of necrosis.

The following forms are possible: carcinomatous miliary spread and carcinomatous meningitis. If the lesion is cortical, it may be accompanied by adjacent meningeal enhancement.

Melanoma metastases have a distinctive appearance: T1 hyperintensity and T2 hypointensity due to the paramagnetic effect of melanin.

Management

  • Anticonvulsant treatment in case of epilepsy.
  • Corticosteroids in case of cerebral edema.
  • Surgical resection.
  • Conformal radiotherapy.
  • Chemotherapy.

Differential diagnosis

  • Brain glioma
  • Multifocal inflammatory lesions
  • Lymphoma of brain.