1. 4.1b. Pre-contrast Axial T1 Wtd MRI4.1c. Post-contrast Axial T1 Wtd MRI4.1a. Axial T2 Wtd MRI 4.1d. Post-contrast Sagittal T1 Wtd MRI Patient with Intra-cranial mass. Q1. Diagnosis Please

2. 4.2a. Post-contrast Axial T1 Wtd MRI4.2b. Post-contrast Coronal T1 Wtd MRI Patient with multiple Intra-cranial masses.Q2. Diagnosis Please

3. Abnormal MRI Q3. Diagnosis Please 4.3b. Post-contrast Axial T1 Wtd MRI4.3c. Post-contrast Coronal T1 Wtd MRI4.3a. Pre-contrast Axial T1 Wtd MRI 4.3d. Post-contrast Sagittal T1 Wtd MRI

4. 4.4. Post-contrast Coronal T1 Wtd MRI Abnormal MRI with dural masses Q4. Diagnosis Please

5. 4.5. Post-contrast Axial T1 Wtd MRI Abnormal MRI Q5. Diagnosis Please

6. Fig. 4.1Fig. 4.2Fig. 4.3 Fig. 4.4Fig. 4.5 Cases 4.1 through 4.5 share a common diagnosis. Name the common diagnosis.

7. Fig. 4.1Fig. 4.2Fig. 4.3 Fig. 4.4Fig. 4.5 Cases 4.1 through 4.5 share a common diagnosis. Name the common diagnosis. METASTASES TO THE BRAIN

8. 4.1b. Pre-contrast Axial T1 Wtd MRI4.1c. Post-contrast Axial T1 Wtd MRI4.1a. Axial T2 Wtd MRI 4.1d. Post-contrast Sagittal T1 Wtd MRI 56-year old lady with a history of Breast carcinoma presented with 1-month history of increased difficulty in word finding. Findings: A well-defined enhancing tumor (arrow) is seen within the left frontal lobe with surrounding edema (E in figure A) Diagnosis: Solitary metastatic adenocarcinoma to the brain from breast primary. E

9. 40-year old lady with a history of breast carcinoma diagnosed 6 years ago, presented with headache and ataxia. Findings:Shower of at least 30 metastatic enhancing lesions are seen closely packed together within both Cerebellar hemispheres (yellow arrows) and few lesions also seen within both posterior Fronto-parietal lobes (red arrows) Diagnosis:Multiple metastasis to the brain from breast primary

10. 28-year old male with melanoma presented with severe headaches, treated by chiropractor without relief, and also with blurred vision progressed to diplopia. 4.3b. Post-contrast Axial T1 Wtd MRI4.3c. Post-contrast Coronal T1 Wtd MRI4.3a. Pre-contrast Axial T1 Wtd MRI 4.3d. Post-contrast Sagittal T1 Wtd MRI Findings: Linear enhancement of the subarachnoid space outlining the cerebellar sulci (yellow arrows) and cortical sulci (red arrows). Note the pathology is not seen in non-contrast study (A). Findings:Linear enhancement of the subarachnoid space outlining the cerebellar sulci (arrows in B, C, D) and cortical sulci (small arrows in C,D). Note the pathology is not seen in non-contrast study (A). Diagnosis:Leptomeningeal/subarachnoid spread of melanoma metastasis, proven by cerebrospinal fluid cytology.

11. 4.4. Post-contrast Coronal T1 Wtd MRI 69-year old male with prostate cancer diagnosed 7 years ago, presented with right sided hemiparesis. Findings:Multiple enhancing dural masses involving the left frontal dura (short arrow) and left temporal dura (long arrow) with calvarial metastases (red arrows). Diagnosis:Dural metastases from prostrate carcinoma

12. 50-year old male with renal cell carcinoma Diagnosis:Right temporal calvarial metastasis with a small epidural tumor (arrow head) and an intraventricular metastasis (arrows).

13. Fig. 4.1Fig. 4.3 Fig. 4.4Fig. 4.5 Common primary sites: Lung, Breast, Melanoma, Thyroid, Renal Cell Carcinoma METASTASES TO THE BRAIN Patten of involvement: Intraparenchymal (Figure 4.1) Leptomeningial/Subarachnoid Spread (Figure 4.3) Dural (Figure 4.4) Epidural (Figure 4.5) Intraventricular (Figure 4.5) Hemorrhagic Metastases Renal Breast Melanoma Choriocracinoma MRI is more sensitive than CT imaging to detect metastatic lesions and can detect a lesion as small as a dot (2mm).