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

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).