Jasmin JO and David Schiff

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Jasmin JO and David Schiff Chapter 26 Metastatic Disease and the Nervous System Jasmin JO and David Schiff Copyright © 2014 Elsevier Inc. All rights reserved.

Copyright © 2014 Elsevier Inc. All rights reserved. Figure 26-1 Solitary brain metastasis in a patient with breast carcinoma. A, Postcontrast T1-weighted gadolinium magnetic resonance imaging (MRI) sequence demonstrating peripheral and central enhancement of a mass in the right posterior temporal lobe; B, T2-weighted MRI sequence demonstrates a large field of high signal with finger-like projections in the white matter extending anteriorly within the temporal lobe and posteriorly within the parietal lobe, consistent with vasogenic edema. Copyright © 2014 Elsevier Inc. All rights reserved.

Copyright © 2014 Elsevier Inc. All rights reserved. Figure 26-2 Multiple metastases with intratumoral hemorrhage from metastatic melanoma. A and B, Numerous contrast enhancing lesions are present on T1-weighted postcontrast MR images of the supratentorial and infratentorial brain. C, Several lesions are present, the largest in the left frontal lobe, and show T1 shortening consistent with the presence of blood, with surrounding edema resulting in midline shift towards the contralateral side. Copyright © 2014 Elsevier Inc. All rights reserved.

Copyright © 2014 Elsevier Inc. All rights reserved. Figure 26-3 Skull-base metastases. A 73-year-old patient with history of non–small cell lung carcinoma presented with right cavernous sinus syndrome. MRI demonstrates multiple avidly enhancing lesions within (A) the right Meckel cave and (B) the right jugular foramen. Dural-based metastases also are seen (C) along the inferior surface of the right tentorium. Copyright © 2014 Elsevier Inc. All rights reserved.

Copyright © 2014 Elsevier Inc. All rights reserved. Figure 26-4 Dural metastasis from breast cancer. Axial (A) and coronal (B) T1-weighted, contrast-enhanced brain MR images demonstrating dural thickening along the left parietal convexity. Copyright © 2014 Elsevier Inc. All rights reserved.

Copyright © 2014 Elsevier Inc. All rights reserved. Figure 26-5 Epidural spinal cord compression secondary to metastatic breast cancer. Postcontrast MRI demonstrates (A) numerous metastatic lesions involving nearly all the thoracic vertebral bodies, with greatest involvement at the T9 vertebral body (star). There is mild neuroforaminal encroachment by the tumor at the left T9-10 level (B). Copyright © 2014 Elsevier Inc. All rights reserved.

Copyright © 2014 Elsevier Inc. All rights reserved. Figure 26-6 Intramedullary spinal cord metastases from parotid salivary ductal carcinoma. A, Diffuse expansile hyperintense T2 signal within the thoracic cord. B and C, Enhancing intramedullary lesion, centered at the level of T6. Copyright © 2014 Elsevier Inc. All rights reserved.

Copyright © 2014 Elsevier Inc. All rights reserved. Figure 26-7 Leptomeningeal metastasis from breast carcinoma. Postcontrast MRI demonstrates leptomeningeal enhancement along the left superior cerebellar surface (A), the margin of the frontal horn of the right lateral ventricle (B), and the left foramen of Luschka (C). Copyright © 2014 Elsevier Inc. All rights reserved.