Brain Neoplasm

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  • I’d like to spend the next few moments talking about evaluation of brain neoplasm.
  • Brain neoplasm can either be benign or malignant, either primary or metastatic. Benign neoplasm of the brain can have aggressive tendencies. It is very possible for benign brain neoplasm to transition to a more aggressive lesion. Brain neoplasm of the benign nature tends to be slow-growing. Malignant neoplasm of brain will have an age distribution that is dependent upon the cell type of the tumor that we are speaking of. Impact to the individual for primary brain neoplasm will be as a result either of the mass effect of the growing tumor or by invasion of the surrounding normal tissues. Metastatic cancer to the brain most often occurs in an individual with a history of pre-existing neoplasm. At times, however, the impact of brain neoplasm may be the first sign of the existence of neoplasm elsewhere in the body. Regardless of the type of brain neoplasm we're dealing with, MRI is the modality of choice.
  • In another individual we see the presence of a cystic mass in the posterior fossa. This mass showing a fluid-fluid level on the various sequences related to patient positioning and the magnet. There is minimal mural nodular enhancement of this mass. This again representing a brain neoplasm, a cystic astrocytoma.
  • Here in another individual is evidence for metastatic brain tumor. In this case we see high signal on T2 and proton density resulting from edema and on the T1 image we see variable signal depending on the stage of role of a neoplasm on T1 with contrast wing like enhancement is seen ring like enhancing lesions are fairly typical of metastatic brain neoplasm. This person had a history of known lung carcinoma.
  • In the same individual a vague opacity identified in the right upper lung zone represents the primary neoplasm leading to the metastatic disease seen on the earlier slide.
  • Brain Neoplasm

    1. 1. Brain Neoplasm
    2. 2. Brain Neoplasm • Benign – May have aggressive tendencies – May transition to more aggressive lesion – Tends to be slower growing • Primary malignant – Age distribution for various tumors – Impact due to mass effect or invasion • Metastatic – History of pre-existing neoplasm – May be primary presentation • Brain MRI modality of choice
    3. 3. Astrocytoma • Irregular low attenuation lesion (CT) • Isodense to gray matter central area • Relatively ‘low grade’ • Surrounding edema (black)
    4. 4. Astrocytoma • MRI • Parietal lesion • White representing surrounding edema on T2 images • Contrast enhancement on T1+C T2 T2 T1 T1+C
    5. 5. Meningioma • Medial posterior mass adjacent to the meninges • Slow growing • Minimal mass effect • Intense enhancement T1+C T1+C T1T2
    6. 6. Meningioma • Extra-axial lesion • Impact based on mass effect • May be quite large without symptoms
    7. 7. Cystic Astrocytoma • Cystic mass in posterior fossa • Rim and mural nodule enhancement on contrast – far right image at arrows
    8. 8. Metastatic Brain Tumor • Multiple ring enhancing lesions • Brain edema (white rim T2) • Known lung cancer T 2 P D T 1 T1+ C
    9. 9. Lung Neoplasm • Nodule upper right lung field • Patient with brain metastases

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