NIRL-07 DIAGNOSTIC AMBIGUITIES IN MRI CHANGES IN A PATIENT WITH BRAIN METASTASES AND RECURRENT STROKES

• Published in: Neuro-oncology advances Vol. 6; no. Supplement_1; p. i21
• Main Authors: Prakash, Neal, Chen, Bihong, Fricke, Jeremy, Babikian, Razmig, Salgia, Ravi
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 02-08-2024
• Subjects: Final Category: Neuroimaging/Radiologic Advances
• ISSN: 2632-2498; 2632-2498
• DOI: 10.1093/noajnl/vdae090.068

Abstract Brain magnetic resonance imaging (MRI) sequences, particularly gadolinium enhanced T1 images, diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) are used frequently in clinical practice. These modalities can help distinguish ischemia from brain metastasis, leptomeningeal disease, hypoxic injuries, and other brain lesions. We present a case of a patient with metastatic lung cancer to the brain with progressive hemiplegia, tumor progression, recurrent strokes, hypoxic brain injury and leptomeningeal disease. Sequential MRIs showed chronic DWI hyperintensity that corresponded to metastatic tumor, with superimposed acute DWI hyperintensities at different time intervals that corresponded to either ischemic events, hypoxic events, and/or tumor progression. We highlight the strengths and limitations of current MRI imaging modalities, particularly DWI, in distinguishing tumor progression from acute ischemic events in a patient with metastatic brain cancer. The correct diagnosis is crucial in guiding treatment strategies as the clinical course progresses, particularly in regard to selecting more aggressive anti-thrombotics versus changing cancer treatment, and defining goals of care.