The presentation of brain metastases is similar to that of primary brain tumours with the additional complication that the patient may be unwell with systemic disease. The most sensitive investigation is high-resolution contrast-enhanced MR scan.

Metastases most frequently appear as multiple, discrete, well-demarcated lesions that are hypo-intense on T1 and hyper-intense on T2 and with marked gadolinium enhancement. There is often copious surrounding vasogenic oedema. Up to 20% of lesions revealed in this way are not seen on CT scan where visible lesions again appear as discrete, enhancing masses.

Various reports have suggested that brain metastases are solitary in 20-50% of cases.

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