Differential diagnosis by unenhanced FLAIR T2-weighted magnetic resonance images between solitary high grade gliomas and cerebral metastases appearing as contrast-enhancing cortico-subcortical lesions

Muccio, Carmine Franco; Tarantino, Annachiara; Esposito, Gennaro; Cerase, Alfonso

doi:10.1007/s11060-010-0454-8

Cited by 19 publications

(14 citation statements)

References 29 publications

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“…The occurrence of nCS in around half of our patients with glioblastoma is consistent with prior studies, but in a much larger cohort, reaffirming that the finding is a common feature of glioblastomas. While others have suggested that nCS may be an imaging biomarker of secondary glioblastomas, our results do not support this.…”

Section: Discussionsupporting

confidence: 91%

“…The presence of non‐enhancing cortical signal abnormality (nCS) on T2‐weighted fluid‐attenuated inversion recovery (FLAIR) sequences contiguous with an enhancing glioblastoma has been shown to be a useful feature for differentiating it from other diagnoses, in particular metastatic disease . In the two larger studies, both of which assessed solitary enhancing lesions, nCS occurred in 63% and 44% of patients, respectively . To our knowledge, the prognostic implications of nCS have not been previously assessed, although other authors have studied the prognostic significance of non‐contrast‐enhancing tumour (nCET) in general, and there is growing interest in this topic.…”

Section: Introductionmentioning

confidence: 99%

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Incidence and prognostic significance of non‐enhancing cortical signal abnormality in glioblastoma

et al. 2015

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Incidence and prognostic significance of non‐enhancing cortical signal abnormality in glioblastoma

et al. 2015

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“…In a solitary enhancing cerebral lesion, the presence of non-enhancing involvement of the adjacent cortex, with signal intensity abnormality on FLAIR or T2-weighted imaging, is a frequent and relatively specific sign for glioblastoma (62,63).…”

Section: Advanced Mr Imagingmentioning

confidence: 99%

Intracranial Metastases: Spectrum of Mr Imaging Findings

et al. 2012

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Intracranial metastatic lesions arise through a number of routes. Therefore, they can involve any part of the central nervous system and their imaging appearances vary.Magnetic resonance imaging (MRI) plays a key role in lesion detection, lesion delineation, and differentiation of metastases from other intracranial disease processes.This article is a reasoned pictorial review illustrating the many faces of intracranial metastatic lesions based on the location -intra-axial metastases, calvarial metastases, dural metastases, leptomeningeal metastases, secondary invasion of the meninges by metastatic disease involving the calvarium and skull base, direct or perineural intracranial extension of head and neck neoplasm, and other unusual manifestations of intracranial metastases.We also review the role of advanced MRI to distinguish metastases from high-grade gliomas, tumor-mimicking lesions such as brain abscesses, and delayed post-radiation changes in radiosurgically treated patients.Intracranial metastases occur in approximately 20-40% of patients with cancer and account for up to 40% of all adult brain neoplasms (1, 2). Cancer is the second leading cause of death in the United States, and the incidence continues to rise, with brain metastases representing an increasing challenge to healthcare providers. Early diagnosis of brain metastasis and intensive, aggressive treatment can reduce the symptoms, improve the patient's quality of life, and prolong survival. Therapeutic considerations have to be individualized, and depend on the patient's neurologic status, dissemination of systemic malignancy, number and location of brain metastases, and sensitivity of the primary tumor to radiation and chemotherapy. Magnetic resonance imaging (MRI) plays a major role in the evaluation and management of patients with metastatic brain tumors. The preferred examination providing the best information about the presence, location, and number of intracranial metastases and their response to treatment is contrast-enhanced MRI (CE-MRI) (3 -5). Although brain parenchyma is more frequently involved, extra-axial metastases are the second most common extra-axial neoplasms in the supratentorial compartment, with leptomeningeal metastases accounting for 8 -10% of patients and dural metastases for 3 -4% (6).This article describes the MR findings of various intracranial metastases, based on the lesion's location, and role of advanced MRI. Skull metastasesCarcinomas of the lung, breast, kidney, and prostate are the most frequent primary neoplasm in skull metastasis. Skull metastases are hyperintense on T2-weighted sequences. On pre-contrast T1-weighted sequences skull metastases are more easily detected, where they appear as hypointense focal marrow lesions. CE-MRI findings are superior for detecting lesions, delineating lesion extent, and determining involvement of the underlying dura or brain (6, 7). On CE-MRI, the lesion may enhance to "normal" T1 marrow signal which require fat saturation (6,8). Skull metastases commonly also involve the adja...

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“…MRI may then provide a specific diagnosis from this limited differential, for example by demonstrating the extra-axial location and dural tail of a meningioma (Fig. 4), cortical FLAIR hyperintensity in a glioma [2, 3], the characteristic cystic mass with a contrast-enhancing mural nodule in the case of a haemangioblastoma [10], the presence of additional lesions in a patient with metastatic disease (Fig. 5), or the olfactory groove epicentre of an esthesioneuroblastoma.…”

Section: How We Read Mri and Pet Together In Neuro-oncologymentioning

confidence: 99%

“…Volumetric pre- and post-contrast T1-weighted imaging are important, as one of the key advantages of MRI over PET is the improved anatomical delineation that fine-slice imaging provides. As standard, we also suggest axial T2-weighted imaging, FLAIR (Fluid Attenuated Inversion Recovery), DWI (diffusion-weighted imaging) and a susceptibility-sensitive sequence such as SWI (Susceptibility-Weighted Imaging), as these can provide a confident diagnosis of pathologies such as a glioma [2, 3] or pyogenic abscess [4, 5]. Perfusion-weighted imaging and spectroscopy may be added depending on the differential diagnosis based on PET.…”

Section: Introductionmentioning

confidence: 99%

How we read: the combined use of MRI and novel PET tracers for the characterisation and treatment planning of masses in neuro-oncology

Lasocki

Hicks

2019

Cancer Imaging

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Technical advances in imaging are well demonstrated by MRI (Magnetic Resonance Imaging) and PET (Positron Emission Tomography). Excellent anatomical detail and a lack of ionising radiation make MRI the standard of care for most neuroimaging indications, and advanced sequences are providing an ever-growing ability for lesion characterisation. PET utilising the tracer fluorine-18 fluorodeoxyglucose is widely used in oncology, while newer PET tracers are able to target a growing number of metabolic pathways and cell membrane receptors. The sequential use of these modalities harnesses the strengths of both, providing complementary diagnostic and therapeutic information. Here we outline the ways in which we use MRI and PET in a complementary manner to improve lesion characterisation in neuro-oncology. Most commonly, an abnormality is detected on either PET or MRI, and the addition of the other modality allows a more confident diagnosis and/or demonstrates additional lesions, guiding treatment decisions and, in some cases, obviating the need for biopsy. These modalities may also be combined to guide the treatment of intracranial masses for which the diagnosis is known, such as neuro-endocrine tumour metastases or meningiomas refractory to conventional therapies.

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Differential diagnosis by unenhanced FLAIR T2-weighted magnetic resonance images between solitary high grade gliomas and cerebral metastases appearing as contrast-enhancing cortico-subcortical lesions

Cited by 19 publications

References 29 publications

Incidence and prognostic significance of non‐enhancing cortical signal abnormality in glioblastoma

Incidence and prognostic significance of non‐enhancing cortical signal abnormality in glioblastoma

Intracranial Metastases: Spectrum of Mr Imaging Findings

How we read: the combined use of MRI and novel PET tracers for the characterisation and treatment planning of masses in neuro-oncology

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