Case Of the Week (COW) 08 Dec 2013
Answer:
CYSTIC BRAIN METASTASIS.
Findings:
Irregular rim enhancing cystic lesions without significant perilesional edema is noted in the Right superior frontal white matter. MR Spectroscopy showed no significantly elevated Choline integral values in the perilesional region. Mild intralesional increase of Choline integral values noted. Lipid peaks are elevated (L1/L2 Ratio is increased significantly) No obvious Intratumoral creatine noted.
Discussion:
The case highlights the importance of MR Spectroscopy in differentiating Primary Brain Tumor from Metastases and cystic lesions from necrotic tumors. A High Grade Glioma can be differentiated from Metastases based on the following MR Spectroscopy findings: Clearly defined sharp lipid peaks is L1(1.3ppm), Whereas the L2 peaks (0.9ppm)are less mobile with broad overlapping resonances and to the left of L1. The ratio L1/L2 is usually around 2.6+/- 0.6 in glioma and 3.8+/- 1.4 in Metastases. Metastases are characterized by absence of creatine and No significantly elevated Choline integral values in the perilesional region It also stresses the importance of Chest Screening in patients , especially elderly, with Brain lesions to identify possible Primary.
Contributed By:
Dr. Babu Peter MD, DNB
Associate Professor, Barnard Institute of Radiology
Senior Consultant Radiologist, Aarthi Scans, Chennai
Answer:
CYSTIC BRAIN METASTASIS.
Findings:
Irregular rim enhancing cystic lesions without significant perilesional edema is noted in the Right superior frontal white matter. MR Spectroscopy showed no significantly elevated Choline integral values in the perilesional region. Mild intralesional increase of Choline integral values noted. Lipid peaks are elevated (L1/L2 Ratio is increased significantly) No obvious Intratumoral creatine noted.
Discussion:
The case highlights the importance of MR Spectroscopy in differentiating Primary Brain Tumor from Metastases and cystic lesions from necrotic tumors. A High Grade Glioma can be differentiated from Metastases based on the following MR Spectroscopy findings: Clearly defined sharp lipid peaks is L1(1.3ppm), Whereas the L2 peaks (0.9ppm)are less mobile with broad overlapping resonances and to the left of L1. The ratio L1/L2 is usually around 2.6+/- 0.6 in glioma and 3.8+/- 1.4 in Metastases. Metastases are characterized by absence of creatine and No significantly elevated Choline integral values in the perilesional region It also stresses the importance of Chest Screening in patients , especially elderly, with Brain lesions to identify possible Primary.
Contributed By:
Dr. Babu Peter MD, DNB
Associate Professor, Barnard Institute of Radiology
Senior Consultant Radiologist, Aarthi Scans, Chennai