Brain metastases: an extra-axial lesion mimmicking a meningioma
Past history of left breast carcinoma underwent MRM and chemo-radiotherapy. Headache with dizziness and unsteadiness for a few days.
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A left anterior high frontal extra-axial mass lesion is seen, it shows low T1 and hyperintense T2 signal with intense rather homogenous post-contrast enhancement. The lesion measures 3.2 X 3.1 X 3 cm in its main CC and axial diameters respectively. The lesion shows associated enhancing dural tail along the anterior falx cerebri.The lesion is seen surrounded by vasogenic brain edema with mild compression of the left lateral ventricle frontal horn and body.
MR spectroscopy of that lesion shows:
- shooting choline (Cho) peak with significant depression of the neuronal markers; N-acetyl asparatate (NAA) and creatine (Cr) with increased Ch/NAA and Cho/Cr ratios
- elevated lipid / lactate peak within the central portion of the lesion; more evident at single voxel MR spectroscopy
- no significant elevation of alanine peak
A much smaller ~ 8mm intensely enhancing lesion is seen in the most high anterior left frontal lobe with mild perifocal edema. Another similar 5mm enhancing lesion is seen within the right cerebellar hemisphere.
Brain metastatic deposits with the left anterior frontal extra-axial lesion mimicking meningioma.
- Richiello A, Sparano L, Del Basso De Caro ML et-al. Dural metastasis mimicking falx meningioma. Case report. J Neurosurg Sci. 2004;47 (3): 167-71. Pubmed citation