Presentation
Altered level of consciousness and seizure, also gives history of hemoptysis and significant weight loss.
Patient Data
There is a large well defined homogeneous opacity involving the right upper zone.
There is an irregular heterogeneous ring-enhancing supratentorial lesion (T1 C+) measuring 2.3 x 1.8 cm in the right high parietal region with a central non-enhancing necrotic core. There is significant perilesional edema (vasogenic edema - hyperintense on T2/FLAIR, no restriction on DWI) causing mass effect as evidenced by the effacement of the ipsilateral atrium, lateral ventricle and the adjacent cortical sulci.
DWI image shows a hyperintense (restricted) solid area with a hypointense signal on ADC.
There is prominent lipid/lactate signal (1.3 ppm), elevated choline peak (3.5 ppm), decreased creatine (3.03 ppm) and decreased NAA peak (2.02 ppm) with choline:creatine ratio of 2.16 at the enhancing solid area.
Peak of all the metabolites is normal in the perilesional edema with maintained Hunter angle.
Case Discussion
The patient had a lung mass in the right upper pulmonary lobe.
Solitary lesion is among half of the adult with cerebral metastases where cerebral hemisphere is the commonest site.
Solitary metastases do not spread directly into (and beyond) peritumoral edema, unlike GBM which is demonstrated by choline peak in the peritumoral edema in MRS.
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