Metastatic Intra‐Axial Neoplasia

Annette O. Nusbaum1, Scott W. Atlas2

1 New York Presbyterian Hospital, New York, New York, 2 Stanford University Medical Center, Stanford, California
Publication Name:  Current Protocols in Magnetic Resonance Imaging
Unit Number:  Unit A3.1
DOI:  10.1002/0471142719.mia0301s00
Online Posting Date:  May, 2001
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Abstract

The role of MRI imaging in the metastatic work-up is to detect the spread of tumor to the brain parenchyma, and define the location. Intravenous contrast (gadolinium-DTPA) provides the greatest sensitivity for detecting brain lesions and is almost always indicated except when there is no intravenous access. This unit presents a Basic Protocol for imaging intra-axial brain metastases and specific modifications are discussed for the case of metastatic brain tumors demonstrating evidence of hemorrhage. The sequences described in this unit are based on 1.5 T scanner (Echospeed GE Medical Systems, Milwaukee, Wisconsin), but can be expected to be equally applicable to other field strengths and scanners from other manufacturers.

     
 
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Table of Contents

  • Unit Introduction
  • Basic Protocol: Rule Out (R/O) Non-Hemorrhagic Metastatic Disease
  • Alternate Protocol: R/O Hemorrhagic Metastatic Disease/Metastatic Melanoma
  • Commentary
  • Literature Cited
  • Tables
     
 
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Materials

Basic Protocol: Rule Out (R/O) Non-Hemorrhagic Metastatic Disease

 Materials
  • Normal saline (0.9% NaCl), sterile
  • Intravenous contrast agent (e.g., Magnevist, Omniscan, or Prohance)
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Figures

Videos

Literature Cited

Literature Cited
    Atlas, S.W. and Lavi, E. 1996. Intra-axial brain tumors. In Magnetic Resonance Imaging of the Brain and Spine, 2nd ed. (S.W. Atlas, ed.) pp. 315-422. Lippincott-Raven, Philadelphia.
    Atlas, S.W. and Thulborn, K.R. 1998. MR detection of hyperacute parenchymal hemorrhage of the brain. Am. J. Neuroradiol. 19:1471-1477.
    Atlas, S.W., Grossman, R.I., Gomori, J.M., Guerry, D., Hackney, D.B., Goldberg, H.I., Zimmerman, R.A., and Bilaniuk, L.T. 1987. MR imaging of intracranial metastatic melanoma. J. Comput. Assist. Tomogr. 11:577-582.
    Atlas, S.W., Mark, A.S., Grossman, R.I., and Gomori, J.M. 1988. Intracranial hemorrhage: Gradient-echo MR imaging at 1.5 T. Radiology. 168:803-807.
    Davey, P. 1999. Brain metastases. Curr. Probl. Cancer 23:59-98.
    Healy, M.E., Hesselink, J.R., Press, G.A., and Middleton, M.S. 1987. Increased detection of intracranial metastases with intravenous Gd-DTPA. Radiology. 165:619-624.
    Johnson, J.D. and Young, B. 1996. Demographics of brain metastasis. Neurosurg. Clin. N. Am. 7:337-344.
    Shellock, F.G. 1996. Pocket Guide to MR Procedures and Metallic Objects. Lippincott-Raven, Philadelphia.
    Thulborn, K.R. and Atlas, S.W. 1996. Intracranial hemorrhage. In Magnetic Resonance Imaging of the Brain and Spine, 2nd ed. (S.W. Atlas, ed.) pp. 265-314. Lippincott-Raven, Philadelphia.
    Thulborn, K.R., Sorensen, A.G., Kowall, N.W., McKee, A., Lai, A., McKinstry, R.C., Moore, J., Rosen, B.R., and Brady, T.J. 1990. The role of ferritin and hemosiderin in the MR appearance of cerebral hemorrhage: A histopathologic biochemical study in rats. Am. J. Neuroradiol. 2:291-297.
    Yuh, W.T., Tali, E.T., Nguyen, H.D., Simonson, T.M., Mayr, N.A., and Fisher, D.J. 1995. The effect of contrast dose, imaging time, and lesion size in the detection of intracerebral metastasis. Am. J. Neuroradiol. 16:373-380.
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