Brain metastases: an extra-axial lesion mimmicking a meningioma

Case contributed by Dr Mohammad A. ElBeialy


Past history of left breast carcinoma underwent MRM and chemo-radiotherapy. Headache with dizziness and unsteadiness for a few days.

Patient Data

Age: 48-year-old
Gender: Female

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.

Case Discussion

Brain metastatic deposits with the left anterior frontal extra-axial lesion mimicking meningioma.

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Case information

rID: 23816
Published: 9th Feb 2016
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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