Board Review 3 – Case 5

Neuroradiology board review. This lecture is geared towards the ABR core exam for residents, but it would be useful for review for the ABR certifying exam or certificate of added qualification (CAQ) exam for neuroradiology.

More description and the answer (spoiler!) are seen below the video.

This case shows multiple hemorrhagic and hyperdense masses on a CT. They are predominantly supratentorial, have some edema, and are numerous.

On MRI, the regions have areas of susceptibility (dark T2 signal on GRE), surrounding edema, and enhance avidly.

The diagnosis is: metastatic disease

Intracranial metastases are extremely common and should be considered any time there are multiple masses (although 50% may be solitary). They can have hemorrhage and almost always enhance on post-contrast imaging. The most common locations are supratentorial and at the gray white junction because of the high vascularity there.

Metastases are treated with surgery or radiation. If there is oligometastatic disease (less than 10-20 lesions), stereotactic radiosurgery may be performed. Numerous lesions or leptomeningeal disease can require whole brain radiotherapy.