Current and Future Management of Brain Metastasis

Editor(s): Kim D.G. (Seoul) 
Lunsford L.D. (Pittsburgh, Pa.) 
Table of Contents
Vol. 25, 2012
Section title: General Management
Kim DG, Lunsford LD (eds): Current and Future Management of Brain Metastasis. Prog Neurol Surg. Basel, Karger, 2012, vol 25, pp 55–73

Imaging Diagnosis of Brain Metastasis

Barajas Jr. R.F. · Cha S.
Departments of aRadiology and Biomedical Imaging and bNeurological Surgery, University of California, San Francisco, Calif, USA

Individual Users: Register with Karger Login Information

Please create your User ID & Password

Contact Information

I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in


Hematogeneous spread of primary neoplasm can result in central nervous system (CNS) disease burden in various anatomically distinct regions; calvarial, pachymeningeal, leptomeningeal, and intraparenchymal. The choice of imaging modality is dependent on the individual clinical situation, but, largely depends on the patients overall clinical status and the information needed to make treatment decisions. Contrast-enhanced magnetic resonance (MR) imaging is the preferred imaging modality of choice; however, computed tomography (CT) is often utilized as the first-pass screening modality for CNS disease. Despite the superior soft tissue resolution, multiplanar capability, and noninvasive nature of MR imaging, T1- and T2-weighted sequences are limited to delineating morphologic anatomical deraignment of tissues by tumor. Several physiology based MR imaging sequences have been developed which compliment anatomic MR imaging. Proton magnetic resonance spectroscopic and dynamic susceptibility contrast-enhanced perfusion-weighted imaging are two physiologic sequences which add additional diagnostic information allowing for improved tumor characterization. Common pitfalls in evaluating for metastatic disease burden include the misidentification of non-neoplastic hematomas, remote microvascular ischemia, and acute onset of ischemic stroke. In the pediatric population, CNS metastases are rare; however, the onset of acute neurological symptoms in a child with known primary tumor should prompt imaging of the neuroaxis.

Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.


  1. Nussbaum ES, Djalilian HR, Cho KH, Hall WA: Brain metastases: histology, multiplicity, surgery, and survival. Cancer 1996;78:1781-1788
  2. Das A, Hochberg FH: Clinical presentation of intracranial metastases. Neurosurg Clin N Am 1996;7:377-391
  3. Cha S: Neuroimaging in neuro-oncology. Neurotherapeutics 2009;6:465-477
  4. Ortiz O, Schochet S, Bastug D: Imaging evaluation and clinicopathologic correlation of mass lesions involving the calvaria. II. Tumoral and inflammatory lesions. Int J Neuroradiol 1999;5:151-165
  5. Garfinkle J, Melançon D, Cortes M, Tampieri D: Imaging pattern of calvarial lesions in adults. Skeletal Radiol 2010;[Epub ahead of print]
  6. Tyrrell RL, 2nd, Bundschuh CV, Modic MT: Dural carcinomatosis: MR demonstration. J Comput Assist Tomogr 1987;11:329-332
  7. Mahendru G, Chong V: Meninges in cancer imaging. Cancer Imaging 2009;9:(spec No A)S14-21
  8. Demopoulos A: Leptomeningeal metastases. Curr Neurol Neurosci Rep 2004;4:196-204
  9. Ribeiro HB, Paiva TF, Jr, Mamprin GP, Gorzoni ML, Rocha AJ, Lancellotti CL: Carcinomatous encephalitis as clinical presentation of occult lung adenocarcinoma: case report. Arq Neuropsiquiatr 2007;65:841-844
  10. Olsen WL, Winkler ML, Ross DA: Carcinomatous encephalitis: CT and MR findings. AJNR 1987;8:553-554
  11. Nemzek W, Poirier V, Salamat MD, Yu T: Carcinomatous encephalitis (miliary metastases): lack of contrast enhancement. AJNR 1993;14:540-542
  12. Walker MT, Kapoor V: Neuroimaging of parenchymal brain metastases. Cancer Treat Res 2007;136:31-51
  13. Chalela JA, Gomes J: Magnetic resonance imaging in the evaluation of intracranial hemorrhage. Expert Rev Neurother 2004;4:267-273
  14. Aygun N, Masaryk TJ: Diagnostic imaging for intracerebral hemorrhage. Neurosurg Clin N Am 2002;13:313-334
  15. Bradley WG: MR appearance of hemorrhage in the brain. Radiology 1993;189:15-26
  16. Schlemmer HP, Bachert P, Herfarth KK, Zuna I, Debus J, van Kaick G: MR spectroscopic evaluationof suspicious brain lesions after stereotactic radiotherapy. Am J Neuroradiol 2001;22:1316-1324
  17. Hollingworth W, Medina LS, Lenkinski RE, Shibata DK, Bernal B, Zurakowski D, Comstock B, Jarvik JG: A systematic literature review of magnetic resonance spectroscopy for the characterization of brain tumors. Am J Neuroradiol 2006;27:1404-1411
  18. Rock JP, Hearshen D, Scarpace L, Croteau D, Gutierrez J, Fisher JL, Rosenblum ML, Mikkelsen T: Correlations between magnetic resonance spectroscopy and image-guided histopathology, with special attention to radiation necrosis. Neurosurgery 2002;51:912-919
  19. Barajas RF, Chang JS, Sneed PK, Segal MR, McDermott MW, Cha S: Distinguishing recurrent intra-axial metastatic tumor from radiation necrosis following gamma knife radiosurgery using dynamic susceptibility-weighted contrast-enhanced perfusion MR imaging. Am J Neuroradiol 2009;30:367-372
  20. Cha S, Lupo JM, Chen MH, Lamborn KR, McDermott MW, Berger MS, Nelson SJ, Dillon WP: Differentiation of glioblastoma multiforme and single brain metastasis by peak height and percentage of signal intensity recovery derived from dynamic susceptibility-weighted contrast-enhanced perfusion MR imaging. Am J Neuroradiol 2007;28:1078-1084
  21. Bronen RA, Fulbright RK, Spencer DD, Spencer SS, Kim JH, Lange RC: MR characteristics of neoplasms and vascular malformations associated with epilepsy. Magn Reson Imaging 1995;13:1153-1162
  22. Kebudi R, Ayan I, Görgün O, Ağaoğlu FY, Vural S, Darendeliler E: Brain metastasis in pediatric extracranial solid tumors: survey and literature review. J Neurooncol 2005;71:43-48
  23. Curless RG, Toledano SR, Ragheb J, Cleveland WW, Falcone S: Hematogenous brain metastasis in children. Pediatr Neurol 2002;26:219-221

Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50