Intracranial tumors (summary)
Dr Derek Smith ◉ et al.
This is a basic article for medical students and other non-radiologists
Intracranial tumors comprise a heterogeneous group of tumors. In adult patients, the majority represent metastatic disease with a smaller proportion being primary brain tumors. Metastasis to the brain occurs, most commonly, from lung, breast, melanoma, renal cell, and colorectal cancers.
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Reference article
This is a summary article; read more in our article on intracranial tumors.
Summary
-
epidemiology
- incidence increases with age
- equivocal gender distribution
- risk factors
- malignancy elsewhere
-
presentation
- headache
- features of raised intracranial pressure
- nausea & vomiting worse in the morning or positional
- altered mental state
- focal neurology may occur as the tumor grows
- adult-onset seizures
- incidental finding
- some tumors may not cause symptoms
- patients may be imaged for another reason, e.g. trauma
-
pathophysiology
- heterogeneous group of tumors
- metastases, e.g. lung, breast, renal
- meningiomas
- primary parenchymal tumors
- pituitary or pineal tumors
- cranial nerve schwannomas
- tumors are graded using the WHO grade
- heterogeneous group of tumors
-
investigation
- CT is often the first test performed to assess presenting symptoms
- MRI may be used with symptoms of headaches or seizures
- MRI is the investigation of choice to characterize the tumor
-
treatment
- parenchymal brain tumors generally have a poor prognosis
- treatment should be in specialist centers
- steroids may alleviate symptoms caused by edema
- anti-epileptic agents may help for those with seizures
- a biopsy may be performed neurosurgically
- some tumors may be removed, e.g. pituitary tumors
- stereotactic radiotherapy can be used for small lesions
Imaging
-
role of imaging
- confirm intracranial abnormality and prioritise MRI
- tumor characterization
- help to determine the grade, and make a decision about biopsy
- follow up
-
radiographic features
- CT
- often the first line test
- variety of appearances depending on the tumor
- hypo- or hyperdense, irregular, well-defined, peripheral or deep
- useful to determine edema and mass effect
- contrast may make lesions more conspicuous
- CT is especially helpful for determining bony involvement
- MRI
- investigation of choice
- fantastic contrast and spatial resolution
- origin of tumors can be determined
- different sequences are used to determine the likely diagnosis
- specialized sequences can be useful to look at tumor metabolites
- CT
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