Presentation
Signs of raised intracranial pressure in a pregnant patient known for breast carcinoma.
Patient Data
Right cerebellar intra-axial mass measuring 48 X 40 X 34 mm, of iso-to low signal on T1 to the cortical grey matter, isosignal T2 and FLAIR. The central area is of low signal with no restricted diffusion. Peritumoural vasogenic oedema demonstrates facilitated diffusion. The 4tn ventricle is compressed and displaced to the right with dilated 3rd and lateral ventricles with no significant transependymal oedema.
The multivoxel MR spectroscopy demonstrates a dominant peak in Lipids / Lactate (LL), elevated choline as well as choline/creatine ratio, and decreased creatine and NAA peak. Depressed metabolites within vasogenic oedema around the tumour (not shown).
Case Discussion
MRI features of a right cerebellar mass compressing the 4th ventricle with obstructive hydrocephalus most consistent with cerebellar metastasis.
The use of gadolinium contrast in pregnant patients is relatively contraindicated due to gadolinium crossing the placental barrier and the unknown effects on the fetus.
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