A systematic approach to diagnosis of cystic brain lesions

Abstract

Brain metastasis is the most common intracranial tumor in adults. The incidence of brain metastasis is rising with the increase in survival of cancer patients. Magnetic resonance imaging with contrast enhancement is the imaging procedure of choice to diagnose and characterize brain metastases. Multiple lesions with marked vasogenic edema and mass effect are typically seen in patients with brain metastases. The classical appearance of a metastasis is a solid enhancing mass with well-defined margins and extensive edema. Occasionally, central necrosis produces a ring enhancing mass. Here, we report a case of Non Small Cell Lung Cancer with multiple ring enhancing lesions in brain, and the approach to diagnosis of such patients.

Keywords: Cystic brain metastases; magnetic resonance imaging; neurocysticercosis.

Figure 1

T1w post gad axial contrast enhanced magnetic resonance (CEMR) multiple ring and disc enhancing lesions noted in the bilateral cerebral and cerebellar hemispheres with surrounding perilesional edema

Figure 2

T1w post gad axial – contrast enhanced magnetic resonance (CEMR) – multiple ring and disc like enhancing lesions noted in the bilateral cerebral hemisphere with surrounding perilesional edema

Figure 3

T1w post gad axial – contrast enhanced magnetic resonance (CEMR) – multiple ring and disc like enhancing lesion noted in the bilateral cerebral hemisphere with surrounding perilesional edema

Figure 4

Post Whole Brain Radiotherapy (WBRT) Non Contrast Computerized Tomography (NCCT) head dated 18/10/12 showing mild dilatation of the ventricular system. Multiple enhancing nodules and perilesional edema seen in both cerebral and cerebellar hemispheres on the previous magnetic resonance imaging scan appears to have completely regressed