File:Cerebellar metastasis - adenocarcinoma lung (Radiopaedia 63184-71715 Axial T2 12).png

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Cerebellar_metastasis_-_adenocarcinoma_lung_(Radiopaedia_63184-71715_Axial_T2_12).png ‎(406 × 448 pixels, file size: 193 KB, MIME type: image/png)

Summary:

Description
  • Radiopaedia case ID: 63184
  • Image ID: 42566328
  • Image stack position: 12/28
  • Plane projection: Axial
  • Aux modality: T2
  • Study findings: A ring enhancing left cerebellar hemisphere lesion, which is favored to be intra-axial is T1 hypointense, and T2 hypointense to grey matter. In addition to the rim of contrast enhancement, it contains 2 central enhancing nodules. Faint susceptibility artefact is present in its rim, but there is no diffuse susceptibility blooming to suggest internal hemorrhage. The lesion demonstrates diffusion restriction (ADC = 600 x 10^-6 mm2/s), corresponding to the non-enhancing central content rather than enhancing rim and nodules. MR spectroscopy demonstrates an elevated lactate peak, with reversal of the choline:creatine ratio. It causes significant adjacent T2/FLAIR hyperintensity, consistent with vasogenic edema. There is mass effect with compression of the fourth ventricle/cerebellar vermis and rightward deviation of the superior medullary velum. The lateral and third ventricles are slightly larger than expected for age, suggesting mild obstructive hydrocephalus. Conclusion: Ring-enhancing 2cm left cerebellar mass with posterior fossa mass effect resulting in mild obstructive hydrocephalus, in the context of a right upper lobe and paratracheal nodal complex conglomerate mass. The presence of diffusion restriction in the non-enhancing or poorly enhancing internal portion of the mass raises suspicion for cerebral abscess (including tuberculous), the morphologic appearance is not entirely classic and occasionally the contents of a metastasis can demonstrate restricted diffusion.
  • Modality: MRI
  • System: Central Nervous System
  • Findings: There is a mass in the periphery of the left cerebellar hemisphere. This has a hyperdense rim the non-contrast images. The entire mass enhances however there is more vivid enhancement peripherally. There is extensive surrounding vasogenic edema with mass effect resulting in partial effacement of the 4th ventricle. There is hydrocephalus with dilatation of the temporal horns. No tonsillar herniation. The adjacent left transverse sinuses opacities normally. The mastoid air cells and paranasal sinuses are clear.
Date Published: 23rd Sep 2018
Source https://radiopaedia.org/cases/cerebellar-metastasis-adenocarcinoma-lung
Author Frank Gaillard
Permission
(Permission-reusing-text)		 http://creativecommons.org/licenses/by-nc-sa/3.0/

Licensing:

Attribution-NonCommercial-ShareAlike 3.0 Unported (CC BY-NC-SA 3.0)

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current07:01, 16 July 2021Thumbnail for version as of 07:01, 16 July 2021406 × 448 (193 KB)Fæ (talk | contribs)Radiopaedia project rID:63184 (batch #6663-40 B12)

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