Intracerebral metastases CT

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

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]

• 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

• 
  _{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 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 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]}
• 
  _{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]}
• 
  _{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]}
• 
  _{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]}
• 
  _{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 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]}

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