Bone Based Dural Based Leptomeningeal and Brain Metastases

Computed tomography scan or MR imaging of skull metastases shows bony erosion or abnormal bone signal and soft tissue masses, which may extend into the soft tissues of the scalp or push through the inner table of the skull (Egelhoff and Zalles 1996). Dural

Figure 10.3 a,b

Intracerebral metastases.a Patient I.Axial post-contrast CT of the brain reveals a hemorrhagic left posterior frontal brain metastasis. b Patient 2. Post-contrast axial T1-weighted image of the brain demonstrates a left frontal brain metastasis disease, which is common, may be well demonstrated with either contrast-enhanced CT scan or MR imaging. Once through the dura, these tumors can impinge on the brain parenchyma. Sphenoid bone involvement may extend into the orbits as a soft tissue mass causing proptosis. Diffuse leptomeningeal disease may be visualized by CT (Sener 1993) or MRI. Although MR with gadolinium contrast has high sensitivity in detecting meningeal metastasis, occasionally false-positive results can be seen following general anesthesia and lumbar puncture. Intracerebral metastatic lesions are usually solid (Kramer et al. 2001) and occasionally hemorrhagic (Aronson et al. 1995) (Fig. 10.3) or cystic (Kenny et al. 1995). These cystic lesions may display contrast-enhancing rims and be confused with infection or inflammation.

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