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Clinical Presentations, Differential Diagnosis, and Imaging Work-Up of Cerebral Mass Lesions

Clinical Neuroradiology

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Abstract

A brain mass lesion can have a myriad of etiologies and may present acutely or be of insidious onset. Symptoms are related to the lesion location, degree of tissue swelling, and rapidity of its onset. Neoplasms can arise from a variety of structures, including glial and neuronal cells, the meninges, ventricular elements, and gland tissue; furthermore, a number of somatic metastases may spread to the brain. Clinical neuroradiology plays an important role by considering non-neoplastic space occupying brain lesions, ranging from infectious processes (encephalitis, cerebritis, cerebral abscess) to tumefactive demyelination, vascular (arterial and venous infarction), autoimmune (sarcoidosis, Ig4 disease, vasculitis), toxic-metabolic and transient (e.g., postictal swelling) conditions. Tumor mimics are often, but not always identifiable through pattern recognition, using a combination of structural MR imaging sequences and advanced techniques, including follow-up radiological techniques where appropriate. Advanced imaging techniques can provide physiological and quantifiable data to aid the distinction of nonneoplastic disease from tumors, as well as the characterization of different brain tumor types. Nonneoplastic entities are discussed in depth in other chapters of this book, but will be briefly addressed where these are relevant in terms of morphological similarities.

This publication is endorsed by: European Society of Neuroradiology (www.esnr.org).

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Abbreviations

ACRIN:

American College of Radiology Imaging Network

ADC:

Apparent Diffusion Coefficient

APT:

Amide Proton Transfer

ASL:

Arterial Spin Labeling

BOLD:

Blood Oxygen Level-Dependent

CEST:

Chemical Exchange Saturation Transfer

Cho:

Choline

[11C] Choline:

Carbon-11-Choline

CNS:

Classification of central nervous system

Cr:

Creatine

CSF:

Cerebrospinal fluid

CT:

Computed Tomography

DCE:

Dynamic Contrast Enhanced

DOTA:

1,4,7,10-Tetraazacyclododecane-1,4,7,10-Tetraacetic acid

DTI:

Diffusion Tensor Imaging

DSC:

Dynamic Susceptibility Contrast

DWI:

Diffusion Weighted Imaging

EORTC:

European Organisation for Research and Treatment of Cancer

[18F] choline:

8F-Fluorinated Choline

[18F] FDG:

Fluorodeoxyglucose F 18

FDOPA:

[18F]-Dehydroxyphenylalanine

FET:

[18F] Fluoroethyl-L-Tyrosine

FLAIR:

Fluid-Attenuated Inversion Recovery

fMRI:

Functional MRI

Gad:

Gadolinium

68Ga-DOTATOC:

68Gallium-DOTA-Tyr3-Octreotide

Glx:

Glutamate/Glutamine

HIV:

Human Immunodeficiency Viruses

ITSS:

Intratumoral Susceptibility Signal

K trans :

Transfer Coefficient

MET:

[11C]Methionine

MI:

Myo-Inositol

MRI:

Magnetic Resonance Imaging

MRS:

MR spectroscopy

NAA:

N-Acetyl Aspartate

NBTS:

United States National Brain Tumor Society

PCNSL:

Primary Central Nervous System Lymphoma

PET:

Positron-Emission Tomography

PNET:

Primitive Neuroectodermal Tumor

ppm:

Parts per million

PWI:

Perfusion-weighted MRI

PXA:

Pleomorphic XanthoAstrocytoma

QUIBA:

Quantitative Biomarkers Alliance

rCBF:

Relative Cerebral Blood Flow

rCBV:

Relative Cerebral Blood Volume

T1w:

T1-weighted images

T2w:

T2-weighted images

TE:

Echo Time

TNM:

Tumor, node, metastasis

Ve:

Extravascular extracellular space

Vp:

Plasma volume

WHO:

World Health Organisation

3D:

Volumetric

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Authors and Affiliations

  1. Neuroradiology, Department of Diagnostics and Pathology, Verona University Hospital, Verona, Italy

    Francesca Benedetta Pizzini

  2. Department of Brain, Repair and Rehabilitation, Neuroradiological Academic Unit, UCL Institute of Neurology, London, UK

    Stefanie Thust & Rolf Jäger

  3. Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK

    Stefanie Thust & Rolf Jäger

  4. Imaging Department, University College London Hospitals, London, UK

    Stefanie Thust & Rolf Jäger

Authors
  1. Francesca Benedetta Pizzini
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  2. Stefanie Thust
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  3. Rolf Jäger
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Corresponding author

Correspondence to Rolf Jäger .

Editor information

Editors and Affiliations

  1. Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands

    Frederik Barkhof

  2. National Hosp.f Neurology & Neurosurgery, UCL National Hosp.f Neurology & Neurosurgery, London, UK

    Rolf Jager

  3. Division of Neuroradiology, University Hospital Vienna Division of Neuroradiology, Wien, Austria

    Majda Thurnher

  4. Department of Neuroradiology, Hospital Vall d’Hebrón Department of Neuroradiology, Barcelona, Spain

    Alex Rovira Cañellas

Section Editor information

  1. University College London, London, UK

    Rolf Jäger

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Pizzini, F.B., Thust, S., Jäger, R. (2019). Clinical Presentations, Differential Diagnosis, and Imaging Work-Up of Cerebral Mass Lesions. In: Barkhof, F., Jager, R., Thurnher, M., Rovira Cañellas, A. (eds) Clinical Neuroradiology. Springer, Cham. https://doi.org/10.1007/978-3-319-61423-6_56-1

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  • DOI: https://doi.org/10.1007/978-3-319-61423-6_56-1

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-61423-6

  • Online ISBN: 978-3-319-61423-6

  • eBook Packages: Springer Reference MedicineReference Module Medicine

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Chapter history

  1. Latest

    Clinical Presentations, Differential Diagnosis, and Imaging Workup of Cerebral Mass Lesions
    Published:
    27 September 2023

    DOI: https://doi.org/10.1007/978-3-319-61423-6_56-2

  2. Original

    Clinical Presentations, Differential Diagnosis, and Imaging Work-Up of Cerebral Mass Lesions
    Published:
    11 April 2019

    DOI: https://doi.org/10.1007/978-3-319-61423-6_56-1

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