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Diagnostic Accuracy of MRI Compared to CCT in Patients with Brain Metastases

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Abstract

Objectives. In patients with extracranial neoplasms, the occurrence and number of brain metastases (BM) are critical for further diagnostic approaches and therapeutic strategies and the patient's prognosis. Although widely accepted, there is surprisingly little evidence in the literature that MRI is superior to CCT. Therefore, in patients with solitary BM according to diagnostic contrast-enhanced computed tomography (CCT), we investigated, what additional information could be gained by contrast-enhanced magnetic resonance imaging (MRI).

Methods/Results. Among 55 patients with solitary BM according to CCT, 17 had multiple BM on MRI (31%) and 38 had solitary BM in both. Based on a presumed binomial distribution of our data, we calculated a rate of at least 19% of patients with solitary BM on CCT, in which MRI would show multiple lesions (p=0.05). The two main characteristics for BM missed by CCT were the smaller diameter, which averages 2 cm less than in BM identified with both modalities, and a preferential frontotemporal location.

Conclusion. MRI is indeed superior to CCT in the diagnosis of BM the essential reasons besides detection of smaller lesions being a better soft tissue contrast, significantly stronger enhancement with paramagnetic contrast agents, the lack of bone artifacts, fewer partial volume effects, and direct imaging in three different planes. Therefore, MRI is indispensable in the diagnostic workup of patients with BM for choosing the optimum therapeutic approach, especially with regard to the decision whether to operate or to primarily irradiate the patient's metastases.

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References

  1. Patchell RA: Brain metastases. Neurol Clin 9(4): 817–824, 1991

    Google Scholar 

  2. Zimm S, Wampler GL, Stablein D, Hazra T, Young HF: Intracerebral metastases in solid-tumor patients: natural history and results of treatment. Cancer 48(2): 384–394, 1981

    PubMed  Google Scholar 

  3. Chason JL, Walker FB, Landers JW: Metastatic carcinoma in the central nervous system and dorsal root ganglia – a prospective autopsy study. Cancer 16(June): 781–787, 1963

    Google Scholar 

  4. Pladdet I, Boven E, Nauta J, Pinedo HM: Palliative care for brain metastases of solid tumour types. Neth J Med 34(1–2): 10–21, 1989

    PubMed  Google Scholar 

  5. Delattre JY, Krol G, Thaler HT, Posner JB: Distribution of brain metastases. Arch Neurol 45(7): 741–744, 1988

    Google Scholar 

  6. Russel DJ, Rubinstein LS: Secondary tumors of the nervous system. In: Pathology of Tumors of the Nervous System. Williams & Wilkins, Baltimore, 1989, pp 825–841

    Google Scholar 

  7. Batson OV: The role of the vertebral veins in metastatic processes. Annals of Internal Medicine 16: 38–45, 1942

    Google Scholar 

  8. Posner JB, Chernik NL: Intracranial metastases from systemic cancer. Adv Neurol 19: 579–592, 1978

    PubMed  Google Scholar 

  9. McIntosh R, Thatcher N: Management of the solitary metastasis. Thorax 45(12): 909–911, 1990

    PubMed  Google Scholar 

  10. Vecht CJ, Haaxma Reiche H, Noordijk EM, Padberg GW, Voormolen JH, Hoekstra FH, Tans JT, Lambooij N, Metsaars JA, Wattendorff AR et al.: Treatment of single brain metastasis: radiotherapy alone or combined with neurosurgery? Ann Neurol 33(6): 583–590, 1993

    PubMed  Google Scholar 

  11. Mandell L, Hilaris B, Sullivan M, Sundaresan N, Nori D, Kim JH, Martini N, Fuks Z: The treatment of single brain metastasis from non-oat cell lung carcinoma. Surgery and radiation versus radiation therapy alone. Cancer 58(3): 641–649, 1986

    PubMed  Google Scholar 

  12. DeAngelis LM, Mandell LR, Thaler HT, Kimmel DW, Galicich JH, Fuks Z, Posner JB: The role of postoperative radiotherapy after resection of single brain metastases. Neurosurgery 24(6): 798–805, 1989

    PubMed  Google Scholar 

  13. Black PM: Solitary brain metastases. Radiation, resection, or radiosurgery? Chest 103(4 Suppl): 367s–369s, 1993

  14. Sawaya R: Neurosurgery issues in oncology. Curr Opin Oncol 3(3): 459–466, 1991

    PubMed  Google Scholar 

  15. Fallai C, Olmi P: Hyperfractionated and accelerated radiation therapy in central nervous system tumors (malignant gliomas, pediatric tumors, and brain metastases). Radiother Oncol 43(3): 235–246, 1997

    PubMed  Google Scholar 

  16. Wowra B, Horstmann GA, Cibis R, Czempiel H: Profile of ambulatory radiosurgery with the gamma knife system. 2: Report of clinical experiences. Radiology 37(12): 1003–1015, 1997

    Google Scholar 

  17. Schoggl A, Kitz K, Ertl A, Dieckmann K, Saringer W, Koos WT: Gamma-knife radiosurgery for brain metastases of renal cell carcinoma: results in 23 patients. Acta Neurochir Wien 140(6): 549–555, 1998

    PubMed  Google Scholar 

  18. Patchell RA, Cirrincione C, ThalerHT, Galicich JH, KimJH, Posner JB: Single brain metastases: surgery plus radiation or radiation alone. Neurology 36(4): 447–453, 1986

    PubMed  Google Scholar 

  19. Patchell RA, Tibbs PA, Walsh JW, Dempsey RJ, Maruyama Y, Kryscio RJ, Markesbery WR, Macdonald JS, Young B: A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med 322(8): 494–500, 1990

    PubMed  Google Scholar 

  20. Smalley SR, Laws ER, Jr JR OF, Shaw EG, Schray MF: Resection for solitary brain metastasis. Role of adjuvant radiation and prognostic variables in 229 patients. J Neurosurg 77(4): 531–540, 1992

    PubMed  Google Scholar 

  21. Davis PC, Hudgins PA, Peterman SB, Hoffman JC Jr: Diagnosis of cerebral metastases: double-dose delayed CT vs contrast-enhanced MR imaging. AJNR 12(2): 293–300, 1991

    PubMed  Google Scholar 

  22. Nemzek W, Poirier V, Salamat MS, Yu T: Carcinomatous encephalitis (miliary metastases): lack of contrast enhancement. AJNR 14(3): 540–542, 1993

    PubMed  Google Scholar 

  23. Sze G, Milano E, Johnson C, Heier L: Detection of brain metastases: comparison of contrast-enhanced MR with unenhanced MR and enhanced CT. AJNR 11(4): 785–791, 1990

    PubMed  Google Scholar 

  24. Sze G, Shin J, Krol G, Johnson C, Liu D, Deck MD: Intraparenchymal brain metastases:MRimaging versus contrastenhanced CT. Radiology 168(1): 187–194, 1988

    PubMed  Google Scholar 

  25. Terrier F, Schuknecht B, Fretz C, Vock P, Herschkowitz N: Magnetic resonance in oncology. Schweiz MedWochenschr 120(35): 1257–1272, 1990

    Google Scholar 

  26. Iaconetta G, Lamaida E, Rossi A, Signorelli F, Manto A, Giamundo A: Leptomeningeal carcinomatosis: reviewof the literature. Acta Neurol Napoli 16(4): 214–220, 1994

    PubMed  Google Scholar 

  27. Watanabe M, Tanaka R, Takeda N: Correlation of MRI and clinical features in meningeal carcinomatosis. Neuroradiology 35(7): 512–515, 1993

    PubMed  Google Scholar 

  28. Healy ME, Hesselink JR, Press GA, Middleton MS: Increased detection of intracranial metastases with intravenous Gd-DTPA. Radiology 165(3): 619–624, 1987

    PubMed  Google Scholar 

  29. Kuhn MJ, Hammer GM, Swenson LC, Youssef HT, Gleason TJ: MRI evaluation of 'solitary' brain metastases with triple-dose gadoteridol: comparison with contrastenhanced CT and conventional-dose gadopentetate dimeglumine MRI studies in the same patients. Comput Med Imaging Graph 18(5): 391–399, 1994

    PubMed  Google Scholar 

  30. Russell EJ, Geremia GK, Johnson CE, Huckman MS, Ramsey RG, Washburn Bleck J, Turner DA, Norusis M: Multiple cerebral metastases: detectability with Gd-DTPAenhanced MR imaging. Radiology 165(3): 609–617, 1987

    PubMed  Google Scholar 

  31. Akeson P, Larsson EM, Kristoffersen DT, Jonsson E, Holtas S: Brain metastases – comparison of gadodiamide injection-enhanced MR imaging at standard and high dose, contrast-enhanced CT and non-contrast-enhancedMR imaging. Acta Radiol 36(3): 300–306, 1995

    PubMed  Google Scholar 

  32. Golfieri R, Cherryman GR, Olliff JF, Husband JE: Comparative evaluation of computerized tomography/magnetic resonance (1.5 T) in the detection of brain metastasis. Radiol Med Torino 82(1–2): 27–34, 1991

    PubMed  Google Scholar 

  33. YuhWT, Engelken JD, Muhonen MG, Mayr NA, Fisher DJ, Ehrhardt JC: Experience with high-dose gadolinium MR imaging in the evaluation of brain metastases. AJNR 13(1): 335–345, 1992

    PubMed  Google Scholar 

  34. Hazuka MB, Burleson WD, Stroud DN, Leonard CE, Lillehei KO, Kinzie JJ: Multiple brain metastases are associated with poor survival in patients treated with surgery and radiotherapy. J Clin Oncol 11(2): 369–373, 1993

    PubMed  Google Scholar 

  35. Salvati M, Cervoni L, Raco A: Single brain metastases from unknown primary malignancies in CT-era. J Neuro-Oncol 23(1): 75–80, 1995

    Google Scholar 

  36. White KT, Fleming TR, Laws ER Jr: Single metastasis to the brain. Surgical treatment in 122 consecutive patients. Mayo Clin Proc 56(7): 424–428, 1981

    PubMed  Google Scholar 

  37. Forsting M, ReithW, Hartmann M, Knauth M: Hochdosierte Gabe von paramagnetischen Kontrastmitteln in der Diagnostik fokaler Hirnlôsionen. Radiology (36): 101–106, 1996

  38. Knauth M, Forsting M, Hartmann M, Heiland S, Balzer T, Sartor K: MR Enhancement of brain lesions: increased contrast dose compared with magnetization transfer. AJNR 17(10): 1853–1859, 1996

    PubMed  Google Scholar 

  39. Yokoi K, Kamiya N, Matsuguma H, Machida S, Hirose T, Mori K, TominagaK: Detection of brain metastasis in potentially operable non-small cell lung cancer: a comparison of CT and MRI. Chest 115(3): 714–719, 1999

    PubMed  Google Scholar 

  40. PerettiViton P, Margain D, Murayama N, Kadr I, Peragut JC: Brain metastases. J Neuroradiol 18(2): 161–172, 1991

    PubMed  Google Scholar 

  41. Higer HP, Pedrosa P, Schuth M: MR imaging of cerebral tumors: state of the art and work in progress. Neurosurg Rev 12(2): 91–106, 1989

    PubMed  Google Scholar 

  42. Claussen C, Laniado M, Kazner E, Schorner W, Felix R: Application of contrast agents in CT and MRI (NMR): their potential in imaging of brain tumors. Neuroradiology 27(2): 164–171, 1985

    PubMed  Google Scholar 

  43. Claussen C, Laniado M, Schorner W, Niendorf HP, Weinmann HJ, Fiegler W, Felix R: Gadolinium-DTPA in MR imaging of glioblastomas and intracranial metastases. AJNR 6(5): 669–674, 1985

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neurology, University of Heidelberg, Germany

    Peter D. Schellinger & Hans M. Meinck

  2. Department of Neuroradiology, University of Aachen, Germany

    Armin Thron

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  1. Peter D. Schellinger
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  2. Hans M. Meinck
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  3. Armin Thron
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Schellinger, P.D., Meinck, H.M. & Thron, A. Diagnostic Accuracy of MRI Compared to CCT in Patients with Brain Metastases. J Neurooncol 44, 275–281 (1999). https://doi.org/10.1023/A:1006308808769

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