Cerebral Metastatic Disease Research Articles

Cerebral Lesions Incidentally Detected on 2-Deoxy-2-[ 18F]Fluoro-D-Glucose Positron Emission Tomography Images of Patients Evaluated for Body Malignancies

Objectives: The purpose of this work was done to evaluate the value of including the brain in the field of view of a whole-body 2-deoxy-2-[ 18F] fluoro-D-glucose positron emission tomography (FDG-PET) study of patients referred for the evaluation of body malignancies. Methods: A total of 1026 consecutive patients were included in this work. The primary diagnoses were the following: lung (n = 253), colorectal (n = 148), head and neck (n = 61), lymphoma (n = 249), melanoma (n = 84), and others (n = 231). Whole-body FDG images including the brain were acquired with a dedicated PET tomograph (GE advance, General Electronic Medical Systems, Milwaukee, WI) one hour after the intravenous administration of 10 mCi of FDG. Two experienced nuclear medicine physicians interpreted the images. Positive findings in the brain or the skull were correlated with other imaging studies and clinical follow-up. Results: Abnormal findings were detected in 3.9% (40/1026) of the patients. Among the 40 abnormal focal lesions, 29 patients had a known history of cerebral disease, cerebrovascular or metastatic disease in most patients. Of the 11 patients without a prior history of cerebral disease, four patients had increased focal FDG uptake suggestive of metastases. Among these, two were proven clinically, one was proven to be a skull base metastasis on MRI, and the other had negative clinical follow-up, but only of two months duration. The other seven patients had a decreased focal FDG uptake most consistent with infarct, one was proven clinically, and the other six had a negative clinical follow-up (mean of 6.3 months, range 1–10), but had multiple risk factors for cerebrovascular disease. Conclusions: We conclude that FDG-PET screening for cerebral lesions in patients with body malignancy has little clinical impact. Unsuspected cerebral or skull metastases were detected in 0.4% (4/1026) of the patients. (Mol Imag Biol 2002;4:359–362)

Cerebral imaging in the asymptomatic preoperative bronchogenic carcinoma patient: Is it worthwhile?

The issue of screening for cerebral metastatic disease in the preoperative bronchogenic carcinoma patient remains unsettled and changes with advancing technology. A prospective nonrandomized study was designed to compare contrast magnetic resonance imaging (MRI) with computed tomography (CT) after several clinical situations suggested improved sensitivity for the former study. Patients with clinically operable disease and normal neurologic examinations were referred for both enhanced cerebral CT and MRI studies. Forty-two patients were entered and completed the enhanced CT scan; only 30 tolerated the MRI. The demographic data and histology of the patients appeared fairly typical for a series of operative candidates. No unsuspected metastatic lesion was found in this selected and low-risk group. We conclude that neither MRI nor enhanced CT scan is indicated in the asymptomatic bronchogenic carcinoma patient due to expense and lack of positive findings. Magnetic resonance imaging demonstrated more subtle benign pathology, but this study did not allow comparison of the two techniques in detection of metastatic disease.

Comparison of spin echo T 1-weighted and FLASH 90° gadolinium-enhanced magnetic resonance imaging in the detection of cerebral metastases

A direct comparison of post-gadolinium FLASH 90 degrees magnetic resonance (MR) images against conventional post-gadolinium T1-weighted spin echo MR images obtained in patients with suspected cerebral metastatic disease shows the FLASH sequence to be inferior. False negative FLASH 90 degrees gadolinium-enhanced MR scans are thought to be a result of either magnetic susceptibility artefact or inferior contrast resolution. False positive FLASH 90 degrees gadolinium-enhanced MR images are a result of either difficulty in interpreting the high signal seen in small vessels or, again, magnetic susceptibility effects. In addition, our study shows small abnormalities suggestive of cerebral metastases on the FLASH 90 degrees gadolinium-enhanced sequences which were not seen on the spin echo T1-weighted gadolinium-enhanced sequences. We believe that spin echo T1-weighted gadolinium-enhanced MR sequences demonstrated 131 out of 139 (94.2%) and FLASH 90 degrees gadolinium-enhanced MR sequences detected 122 out of 139 (87.8%) possible metastases. From this, we conclude that spin echo T1-weighted gadolinium-enhanced MR sequences is a better test than FLASH 90 degrees gadolinium-enhanced MR in the diagnosis of brain metastases and that either sequence alone is limited as a screening test.

An Experimental Model for Cerebral Metastasis Preliminary Light and Ultrastructural Studies

An experimental model for hematogenously spread cerebral metastases by injection of a suspension of M3 fibrosarcoma cells into the carotid artery of C57 BL/6 mice was developed. Intracerebral metastatic tumor nodules were consistently produced by this method with subsequent death of the animals. Development of extracerebral metastatic disease was minimal. Light and electron microscopic studies were carried out at various time intervals postintracarotid injection of tumor cells to observe the morphologic events during the development of the brain metastases. Tumor cells were observed arrested in the cerebral capillaries from 15 minutes to 4 days post-injection. From 1 day to 4 days post-injection, individual tumor cells were also observed in the pericapillary spaces in the brains of the injected animals. From 5 days post-injection on, tumor cells were seen to be proliferating in peri-capillary spaces displacing the brain parenchyma and eventually formed tumor nodules with resulting death of the animals. Morphological changes were observed in the endothelial cells of the blood vessels which were surrounded by the growing metastatic tumors. This model, and modifications thereof, should prove to be valuable in the study of cerebral metastatic disease.

Cerebral metastatic disease in childhood.

Hematogenous cerebral metastases in children with malignant tumors occurred in 13 (6 percent) of 217 brains examined post mortem. Cerebral hemispheres were involve!d in all but one patient with a cerebellar lesion. Clinical manifestations inclluded headache, vomiting, epilepsy, visual disturbances, and focal neuroloyic deficits. Pulmonary involvement by tumor was present before the onset of central nervous system dysfunction in all cases, which suggests that cerebral metastases were seeded through the arterial bloodstream. In five children, radiation therapy or craniotomy followed by irradiation was associated with survivals of 2¹/2 to 20 months

The care of patients with bronchial cancer.

Primary bronchial carcinoma is a pleomorphic disease with predominantly unfavorable characteristics. While it may remain localized for several years, it tends more frequently to relatively early generalization. Karnofsky (3) would divide the clinical types of bronchial cancer into five groups, according to the following general patterns: (a) localized disease; (b) early generalized disease; (c) cerebral metastatic disease; (d) osseous metastatic disease; (e) hepatic metastatic disease. Of 100 consecutive unselected patients in whom bronchial carcinoma is diagnosed, it is currently estimated that about one-half are surgically incurable at the time of diagnosis and about one-half are eligible for surgical exploration. In the latter group, about one-half prove to have non-resectable growths, while the other (or 25 cases) have resectable disease. Of the 25 patients undergoing resection, between 1 and 5 are apt to die as a result of surgery, about 16 will die of their disease within the ensuing five years, and between 4 and 8 will survive five years. If one is fortunate in securing the latter figure, one can correctly claim a 32 per cent five year “cure rate” of the resected group. On the other hand, this represents at best only 8 patients out of the original 100. This is a measure of the problem. Lesions which are peripheral and diagnosed while still “a solitary nodule” naturally have a better prognosis than those which are central and are recognized only when atelectasis or adenopathy is already present. Well differentiated squamous-cell tumors tend to have a better prognosis than poorly differentiated tumors. As clinicians, we are faced with the fact that about 90 per cent of bronchial cancers are still not curable by the optimum method of treatment—surgical excision of the disease while still localized in the lung. This preponderant group, even though incurable, deserves careful and individualized treatment. The first step in planning treatment is to attempt to determine the anatomic extent of disease present, that is, to stage bronchial carcinoma in a manner somewhat similar to that used for cancer in other sites. Such staging must, however, be based on more than the clinical or radiological evidence alone. It requires knowledge of the combined clinical, radiological, bronchoscopic, and microscopic findings. Details concerning this staging have been reported elsewhere (2). It covers both bronchial and bronchiolar carcinoma, it allows for carcinoma in situ (Stage 0) and for carcinomas unclassifiable because of bizarre histologic type of spread (Stage U). In approximately 100 consecutive cases of bronchial cancer so studied, the staging was as follows: The radiotherapist is usually consulted regarding the treatment of patients already in Stage III or IV. For this reason, the results of radiotherapy cannot be compared with those of surgical therapy, since the basic group of patients treated is quite different.