Abstract
Brain metastases are the most common intracranial tumors and occur in 20–40% of all cancer patients. Lung cancer, breast cancer, and melanoma are the most frequent primary cancers to develop brain metastases. Treatment options include surgical resection, whole brain radiotherapy, stereotactic radiosurgery, and systemic treatment such as targeted or immune therapy. Anatomical magnetic resonance imaging (MRI) of the tumor (in particular post-Gadolinium T1-weighted and T2-weighted FLAIR) provide information about lesion morphology and structure, and are routinely used in clinical practice for both detection and treatment response evaluation for brain metastases. Advanced MRI biomarkers that characterize the cellular, biophysical, micro-structural and metabolic features of tumors have the potential to improve the management of brain metastases from early detection and diagnosis, to evaluating treatment response. Magnetic resonance spectroscopy (MRS), chemical exchange saturation transfer (CEST), quantitative magnetization transfer (qMT), diffusion-based tissue microstructure imaging, trans-membrane water exchange mapping, and magnetic susceptibility weighted imaging (SWI) are advanced MRI techniques that will be reviewed in this article as they pertain to brain metastases.
Highlights
Brain metastases originate from a large number of primary cancers in the body with breast cancer, lung cancer and melanoma being the most likely to metastasize to the brain [1]
Dynamic contrast enhanced (DCE)-magnetic resonance imaging (MRI) can be analyzed with a two-compartment Tofts-Kety model to provide quantitative evaluation of vascular permeability and blood flow [16, 17]; dynamic susceptibility contrast (DSC)-MRI characterizes tumor perfusion, relative cerebral blood flow and relative cerebral blood volume [18]; while apparent diffusion coefficient (ADC) measurements calculated from diffusion-weighted MRI reflect tissue cellularity
This study reported no change in the magnetization transfer ratio (MTR) on the contra-lateral normal appearing white matter (cNAWM) of the patients; they measured significantly lower MTR on the ipsilateral NAWM, which may be caused by the destruction of myelin or increased intracellular fluid
Summary
Hatef Mehrabian 1,2*, Jay Detsky 3,4, Hany Soliman 3,4, Arjun Sahgal 1,3,4 and Greg J. National Institutes of Health (NIH), United States Christine Marosi, Medical University of Vienna, Austria. Specialty section: This article was submitted to Neuro-Oncology and Neurosurgical
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