Answer for BIR CoW 11 March 2018
DURAL METASTASES FROM CA PROSTATE
Findings
Large mixed intense heterogenously enhancing dural based extraaxial lesion with few tiny calcific specks noted in the right superior frontal region. There is moderate perilesional edema noted. The lesion exerts mass effect causing compression of the right lateral ventricle frontal horn and body as well as mid line shift to the left. Multivoxel MR Spectroscopy of the lesion revealed significantly increased Lipid Peaks , decreased NAA integral values and relatively increased Choline Integral values . DTI revealed relative compression and displacement of the left cortico spinal tract.
Discussion
The presence of large lipid peaks in a Brain Tumor is suggestive of a high grade glioma or Metastasis. Presence of lipid peak within a non necrotic portion of the tumor is highly suggestive of Metastases . The near complete absence of NAA is again consistent with origin outside the nervous system, as in this dural based lesion . Based on the morphology and MR Spectroscopy findings , Diagnosis of Dural Metastasis could be made confidently . Patient was a Known case of adenocarcinoma prostate. Post orchidectomy , radiotherapy and chemotherapy status .
Findings
Large mixed intense heterogenously enhancing dural based extraaxial lesion with few tiny calcific specks noted in the right superior frontal region. There is moderate perilesional edema noted. The lesion exerts mass effect causing compression of the right lateral ventricle frontal horn and body as well as mid line shift to the left. Multivoxel MR Spectroscopy of the lesion revealed significantly increased Lipid Peaks , decreased NAA integral values and relatively increased Choline Integral values . DTI revealed relative compression and displacement of the left cortico spinal tract.
Discussion
The presence of large lipid peaks in a Brain Tumor is suggestive of a high grade glioma or Metastasis. Presence of lipid peak within a non necrotic portion of the tumor is highly suggestive of Metastases . The near complete absence of NAA is again consistent with origin outside the nervous system, as in this dural based lesion . Based on the morphology and MR Spectroscopy findings , Diagnosis of Dural Metastasis could be made confidently . Patient was a Known case of adenocarcinoma prostate. Post orchidectomy , radiotherapy and chemotherapy status .
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!