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Gamma Knife Neurosurgery in the Management of Intracranial Disorders pp 159–166Cite as

Optimal Visualization of Multiple Brain Metastases for Gamma Knife Radiosurgery

Part of the Acta Neurochirurgica Supplement book series (NEUROCHIRURGICA,volume 116)

Abstract

Background: Optimal management of metastatic brain disease requires precise detection and detailed characterization of all intracranial lesions.

Methods: We analyzed an experience with 3200 brain MRI investigations performed at 1.5 T and 3.0 T for identification and/or evaluation of intracranial metastases. Usually axial T1- and T2-weighted images and contrast-enhanced T1-weighted images in axial and coronal and/or sagittal projections were obtained. Fluid-attenuated inversion recovery and diffusion-weighted imaging were sometimes used as well. Routinely, 0.2 mmol/kg of gadoteridol (ProHance®) was administered intravenously, but the dose was reduced to 0.1 mmol/kg in elderly patients or in patients with mild renal dysfunction.

Findings: Magnetic resonance imaging (MRI) provided excellent information on tumor location; interrelations with functionally important intracranial structures; type of growth; vascularity; recent, old or multiple hemorrhages within or in the vicinity of the mass; presence of peritumoral edema; necrotic changes; subarachnoid dissemination; meningeal carcinomatosis. However, without administration of gado-teridol or without contrast enhancement, small metastatic tumors could not be reliably distinguished from brain lacunes. Some metastases (malignant melanoma, thyroid cancer, endocrine carcinoma, small cell lung carcinoma) may demonstrate specific neuroimaging features. Non-metastatic ­multiple brain lesions caused by vascular, inflammatory, demyelinative or lymphoproliferative diseases require a thorough differential diagnosis with metastatic brain tumors based not only on neuroimaging but on additional analysis of various clinical data.

Conclusion: Contemporary MRI techniques provide excellent options for detection, detailed characterization, and differential diagnosis of metastatic brain tumors, which is extremely important when choosing the optimal treatment strategy, particularly with Gamma Knife radiosurgery.

Keywords

  • Brain metastases
  • Diagnosis
  • Differential diagnosis
  • MRI
  • Multiple brain lesions

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Conflict of Interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan

    Yuko Ono, Kayoko Abe & Shuji Sakai

  2. Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women’s Medical University, Tokyo, Japan

    Motohiro Hayashi, Mikhail F. Chernov & Kintomo Takakura

  3. Department of Neurosurgery, Neurological Institute, Tokyo Women’s Medical University, Tokyo, Japan

    Motohiro Hayashi, Mikhail F. Chernov, Yoshikazu Okada & Kintomo Takakura

Authors
  1. Yuko Ono
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  2. Kayoko Abe
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  3. Motohiro Hayashi
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  4. Mikhail F. Chernov
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  5. Yoshikazu Okada
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  6. Shuji Sakai
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  7. Kintomo Takakura
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Corresponding author

Correspondence to Yuko Ono .

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Editors and Affiliations

  1. , Fac. of Adv. Techno-Surgery, Tokyo Women's Medical University, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan

    Mikhail F. Chernov

  2. , Dept. of Neurosurgery, Tokyo Women's Medical University, Kawada-cho, Shinjuku-ku 8-1, Tokyo, 162-8666, Japan

    Motohiro Hayashi

  3. Oysteinsgate 16, Bergen, 5007, Norway

    Jeremy C. Ganz

  4. Kawada-cho, Shinjuku-ku 8-1, JP-162 8666 TOKYO, Japan

    Kintomo Takakura

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Ono, Y. et al. (2013). Optimal Visualization of Multiple Brain Metastases for Gamma Knife Radiosurgery. In: Chernov, M., Hayashi, M., Ganz, J., Takakura, K. (eds) Gamma Knife Neurosurgery in the Management of Intracranial Disorders. Acta Neurochirurgica Supplement, vol 116. Springer, Vienna. https://doi.org/10.1007/978-3-7091-1376-9_25

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  • DOI: https://doi.org/10.1007/978-3-7091-1376-9_25

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