Improved Detection of Skull Metastasis with Diffusion-Weighted MR Imaging

Nemeth, Alexander J.; Henson, John W.; Mullins, Mark E.; González, Ramón; Schaefer, Pamela W.

doi:10.3174/ajnr.a0501

Cited by 66 publications

(42 citation statements)

References 12 publications

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“…A study by Nemeth et al reported 100% specificity for DW MRI in detecting skull metastasis [4] . It was found that DW MRI was comparable to or more sensitive than FDG-PET/ CT [5,6] .…”

Section: Discussionmentioning

confidence: 99%

Characterization of a parietal lesion detected by diffusion weighted MRI, NaF18-PET/CT and CT

Win

Aparici

2013

JBGC

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It is very important to accurately characterize skull lesions so that appropriate treatment decisions can be made. False positive readings may lead to unnecessary surgical intervention or radiation. We present a case of a parietal lesion seen on Diffusion weighted (DW) MRI, and further characterized with NaF18-PET/CT and CT in a 69 year old male. This is the first case to report the use of DW MRI, NaF18-PET/CT bone scan and CT in the diagnosis of a skull lesion. DW MRI is known to have high specificity to detect malignant lesions in the skull. If a similar case such as ours in encountered in everyday clinical practice, a differential diagnosis of a benign etiology should be considered.

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“…A study by Nemeth et al reported 100% specificity for DW MRI in detecting skull metastasis [4] . It was found that DW MRI was comparable to or more sensitive than FDG-PET/ CT [5,6] .…”

Section: Discussionmentioning

confidence: 99%

Characterization of a parietal lesion detected by diffusion weighted MRI, NaF18-PET/CT and CT

Win

Aparici

2013

JBGC

View full text Add to dashboard Cite

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“…We observed that DW-MRI had the highest sensitivity for detecting cranial bone marrow metastasis of lung cancer, whereas the sensitivity of DW-MRI for detecting cranial bone marrow metastasis of prostate cancer demonstrated the lowest value. Nemeth et al 8 showed that DW-MRI is a useful sequence for identifying focal skull metastases of breast and lung malignancies compared with conventional MRI. However, DW-MRI is insensitive for the detection of sclerotic skull metastases of prostate carcinoma.…”

Section: Discussionmentioning

confidence: 99%

Kraniyal Kemik İliği Metastazlarında Difüzyon Ağırlıklı MR Görüntüleme

Alkan¹,

Peköz²,

Altınkaya³

2015

Cukurova Medical Journal

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Purpose: Diffusion-weighted MR imaging (DW-MRI) is generally applied to diagnose intra-axial brain pathologies such as parenchyma metastasis, abscesses, and infarcts in patients with systemic cancer. This study aimed to evaluate the DW-MRI findings in cranial bone marrow metastases to facilitate diagnosis. Material and Methods: Conventional MR imaging and DW-MRI findings of 57 patients with cranial bone marrow metastases were evaluated retrospectively. These images were evaluated by two neuroradiologists for lesion detection and lesion consciousness. Reader agreement was assessed by κ statistics. Results: Fifty-seven patients exhibited 113 cranial bone marrow metastases. The sensitivities of DW-MRI and the apparent diffusion coefficient to detect cranial bone metastasis for all types of primary malignancy were 86% and 90%, respectively. The sensitivities of T1-weighted imaging (T1WI), fluid attenuation inversion recovery, contrast-enhanced fat-suppressed (CE-FS) T1WI, and T2WI sequences to detect cranial bone metastasis were 93%, 90%, 89%, and 84%, respectively. Regarding lesion conspicuousness, DW-MRI was equivalent to CE-FS T1WI and equivalent or superior to non-contrast conventional sequences in most of the cranial bone marrow metastases. Interobserver agreement was excellent. Conclusions: DW-MRI is generally indicated not only to assess the diagnosis of parenchyma involvement, but also to discover the cranial bone marrow metastasis in patients with systemic cancer. Key words: Cranial bone marrow, metastases, brain MRI, diffusion-weighted MRI ÖZET Amaç: Difüzyon ağırlıklı MR (DAG-MR) görüntüleme genellikle sistemik kanserli hastalarda parankim metastazı, abse ve infart gibi intraaksiyel beyin patolojilerinin tanısında kullanılmaktadır. Bu çalışmada DAG -MR'nin kranial kemik iliği metastazlarının tanısındaki değeri araştırılmıştır. Materyal ve Metod: Kranial kemik iliği metastazı saptanan 57 hastanın konvansiyonel MR ve DAG-MR görüntüleri geriye dönük olarak değerlendirildi. Görüntüler 2 nöroradyolog tarafından lezyon saptanması ve göze çarpıcılığı açısından incelendi. Radyologların kappa uyumuna bakıldı. Bulgular: Elli yedi hastada toplam 113 kranial kemik iliği metastazı saptandı. DAG-MR ve ADC' nin lezyon saptama sensitivitesi sırasıyla %86 and %90 saptandı.T1, FLAIR, kontrastlı yağ baskılamalı T1 ve T2 ağırlıklı sekansların lezyon saptanmasında sensitivitesi sırasıyla %93, %90, % 89, ve %84 saptandı. DAG-MR'nin lezyon göze çarpıcılığı kontrastlı T1 ağırlıklı görüntülere eşit, diğer konvansiyonel sekanslara eşit ya da üstündü. Radyologların kappa uyumu mükemmeldi. Sonuç: DAG-MR sadece parankim tutulumunu değerlendirme değil, kemik iliği metastazlarını da değerlendirmede kullanılabilir Anahtar kelimeler: Kraniyal kemik iliği, metastaz, Beyin MR, Difüzyon MR

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“…1 DWI is helpful in detecting lytic skull metastasis of the skull base. 5 Lytic metastases are hyperintense on DWI because of the attenuated cell packing in highly malignant tumors and T2 shinethrough effect once they are typically hyperintense on T2-weighted imaging. 5 The clival abscess presented as a cystic/ necrotic mass lesion, which is atypical for a metastasis.…”

Section: Discussionmentioning

confidence: 99%

“…5 Lytic metastases are hyperintense on DWI because of the attenuated cell packing in highly malignant tumors and T2 shinethrough effect once they are typically hyperintense on T2-weighted imaging. 5 The clival abscess presented as a cystic/ necrotic mass lesion, which is atypical for a metastasis. In addition, DWI hyperintensity in this case was due to truly restricted diffusion, because the ADC map showed low signal intensity.…”

Section: Discussionmentioning

confidence: 99%

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Diffusion-Weighted MR Imaging Findings in an Isolated Abscess of the Clivus

Soares-Fernandes¹,

Valle-Folgueral²,

Morais³

et al. 2007

AJNR Am J Neuroradiol

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SUMMARY:We report the finding of restricted diffusion in an isolated abscess of the clivus and discuss the imaging differential diagnosis, with an emphasis on the usefulness of diffusion-weighted imaging.T he clivus is an uncommon location for intracranial lesions. Chordoma, chondrosarcoma, plasmocytoma, giant cell tumors, lymphangioma, adenocystic and nasopharyngeal carcinomas, and metastases are lesions known to develop in the clivus.1,2 Secondary clival involvement from sphenoid sinus abscesses and mucopyoceles have been reported and documented by CT and conventional MR imaging. 3,4 We describe the diffusion-weighted imaging (DWI) findings of a primarily clival abscess. Case ReportA 44-year-old woman presented with a 1-month history of progressively worsening hemifacial and hemicranial headaches, nausea, and vomiting. There were no visual complaints or previous history of sinusitis. At examination, the patient was awake and alert, afebrile, with no signs of meningeal irritation. Sensation in the face was intact. Hess screen chart examination revealed incomplete left sixth nerve palsy. CT showed a midline mass lesion with bone erosion, involving the upper clivus and sellar floor ( Fig 1A). MR imaging (1.5T scanners, Symphony and Avanto; Siemens, Erlangen, Germany) demonstrated a cystic-necrotic lesion, with a hypointense rim on T2-weighted turbo spin-echo images and thick peripheral enhancement ( Fig 1B, -C). DWI and apparent diffusion coefficient (ADC) maps demonstrated central restricted diffusion (Fig 2). DWI parameters were as follows: coronal plane, TR ϭ 170 ms, TE ϭ 94 ms, b ϭ 1000 s/mm 2 , section thickness ϭ 3 mm with a 0.5-mm gap, matrix ϭ 218 ϫ 256 ms, and FOV ϭ 20.9 cm. Laboratory analysis failed to reveal leukocytosis (9.7 ϫ 10 9 /L), elevated C-reactive protein (5.3 mg/L), or increased tumor markers. No primary malignancy was detected on cervical, chest, abdominal, or pelvic CT. After 3 weeks of treatment with highdose clindamycin and gentamicin without clinical improvement or imaging findings change, the patient underwent a pretemporal-transsylvian approach to the mass. A smoothened upper clivus due to an abscedated collection was found. No communication between the abscess and the sphenoid sinus was demonstrated. Pathologic examination revealed inflammatory cells but no organisms. Bacterial, mycobacterial, and fungal cultures were obtained, but no organism was cultured, presumably because of administered antibiotics. After surgery, there was resolution of the patient's complaints. Antibiotherapy was administered for another 4 weeks. Imaging follow-up at 3 months showed partial clival bone reconstitution. DiscussionInfectious lesions of the clivus are rare, mainly arising from the sphenoid sinus. Sphenoid mucopyoceles can expand posteriorly, eroding the posterior wall of the sphenoid sinus, and present as a clival mass entrapped by sphenoidal mucosa. The wall defect can be demonstrated either by imaging or by surgery. 3 Clival infection can also result from aggressive sphenoid sinusitis.4 Accura...

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Improved Detection of Skull Metastasis with Diffusion-Weighted MR Imaging

Cited by 66 publications

References 12 publications

Characterization of a parietal lesion detected by diffusion weighted MRI, NaF18-PET/CT and CT

Characterization of a parietal lesion detected by diffusion weighted MRI, NaF18-PET/CT and CT

Kraniyal Kemik İliği Metastazlarında Difüzyon Ağırlıklı MR Görüntüleme

Diffusion-Weighted MR Imaging Findings in an Isolated Abscess of the Clivus

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