4.1b. Precontrast Axial T1 Wtd MRI

1
4.1b. Pre-contrast Axial T1 Wtd MRI
4.1c. Post-contrast Axial T1 Wtd MRI
4.1a. Axial T2 Wtd MRI
Patient with Intra-cranial mass.
Q1. Diagnosis Please
4.1d. Post-contrast Sagittal T1 Wtd MRI
2
4.2a. Post-contrast Axial T1 Wtd MRI
4.2b. Post-contrast Coronal T1 Wtd MRI
Patient with multiple Intra-cranial masses.
Q2. Diagnosis Please
3
4.3b. Post-contrast Axial T1 Wtd MRI
4.3c. Post-contrast Coronal T1 Wtd MRI
4.3a. Pre-contrast Axial T1 Wtd MRI
Abnormal MRI
Q3. Diagnosis Please
4.3d. Post-contrast Sagittal T1 Wtd MRI
4
Abnormal MRI with dural masses
Q4. Diagnosis Please
4.4. Post-contrast Coronal T1 Wtd MRI
5
Abnormal MRI
Q5. Diagnosis Please
4.5. Post-contrast Axial T1 Wtd MRI
6
Fig. 4.1
Fig. 4.2
Fig. 4.3
Cases 4.1 through 4.5 share a common diagnosis.
Name the common diagnosis.
Fig. 4.4
Fig. 4.5
7
Fig. 4.1
Fig. 4.2
Fig. 4.3
Cases 4.1 through 4.5 share a common diagnosis.
Name the common diagnosis.
METASTASES TO THE BRAIN
Fig. 4.4
Fig. 4.5
8
E
4.1b. Pre-contrast Axial T1 Wtd MRI
4.1c. Post-contrast Axial T1 Wtd MRI
4.1a. Axial T2 Wtd MRI
56-year old lady with a history of Breast
carcinoma presented with 1-month history of
increased difficulty in word finding.
Findings A well-defined enhancing tumor (arrow)
is seen within the left frontal lobe with
surrounding edema (E in figure A)
Diagnosis Solitary metastatic adenocarcinoma to
the brain from breast primary.
4.1d. Post-contrast Sagittal T1 Wtd MRI
9
40-year old lady with a history of breast
carcinoma diagnosed 6 years ago, presented with
headache and ataxia.
Findings Shower of at least 30 metastatic
enhancing lesions are seen closely packed
together within both Cerebellar hemispheres
(yellow arrows) and few lesions also seen within
both posterior Fronto-parietal lobes (red arrows)
Diagnosis Multiple metastasis to the brain from
breast primary
10
4.3b. Post-contrast Axial T1 Wtd MRI
4.3c. Post-contrast Coronal T1 Wtd MRI
4.3a. Pre-contrast Axial T1 Wtd MRI
Findings Linear enhancement of the subarachnoid
space outlining the cerebellar sulci (arrows in
B, C, D) and cortical sulci (small arrows in
C,D). Note the pathology is not seen in
non-contrast study (A).
28-year old male with melanoma presented with
severe headaches, treated by chiropractor without
relief, and also with blurred vision progressed
to diplopia.
Findings Linear enhancement of the subarachnoid
space outlining the cerebellar sulci (yellow
arrows) and cortical sulci (red arrows). Note
the pathology is not seen in non-contrast study
(A).
Diagnosis Leptomeningeal/subarachnoid spread of
melanoma metastasis, proven by cerebrospinal
fluid cytology.
4.3d. Post-contrast Sagittal T1 Wtd MRI
11
69-year old male with prostate cancer diagnosed 7
years ago, presented with right sided
hemiparesis.
Findings Multiple enhancing dural masses
involving the left frontal dura (short arrow) and
left temporal dura (long arrow) with calvarial
metastases (red arrows).
Diagnosis Dural metastases from prostrate
carcinoma
4.4. Post-contrast Coronal T1 Wtd MRI
12
50-year old male with renal cell carcinoma
Diagnosis Right temporal calvarial metastasis
with a small epidural tumor (arrow head) and an
intraventricular metastasis (arrows).
13
METASTASES TO THE BRAIN
MRI is more sensitive than CT imaging to detect
metastatic lesions and can detect a lesion as
small as a dot (2mm).
Common primary sites Lung, Breast, Melanoma,
Thyroid, Renal Cell Carcinoma

• Patten of involvement
• Intraparenchymal (Figure 4.1)
• Leptomeningial/Subarachnoid Spread (Figure 4.3)
• Dural (Figure 4.4)
• Epidural (Figure 4.5)
• Intraventricular (Figure 4.5)

Fig. 4.1
Fig. 4.3

• Hemorrhagic Metastases
• Renal
• Breast
• Melanoma
• Choriocracinoma

Fig. 4.4
Fig. 4.5