Magnetic resonance imaging with contrast enhancement for intracranial metastases [Neurosurgery Wiki]

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====== Magnetic resonance imaging with contrast enhancement for intracranial metastases ======


Administration of a gadolinium contrast agent produces higher contrast between tumor and normal brain at 3 tesla than at 1.5 tesla
((Nöbauer-Huhmann IM, Ba-Ssalamah A, Mlynarik V, Barth M, Schöggl A, Heimberger K, Matula C, Fog A, Kaider A, Trattnig S. Magnetic resonance imaging contrast enhancement of brain tumors at 3 tesla versus 1.5 tesla. Invest Radiol. 2002 Mar;37(3):114-9. doi: 10.1097/00004424-200203000-00003. PMID: 11882790.)).
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Contrast-enhanced magnetic resonance imaging (MRI) is the standard imaging technique for determining the number, size, and location of metastatic lesions. In SRS, the capability of MRI to delineate lesion borders precisely in 3 dimensions helps reduce recurrence rates and minimize radiation necrosis in surrounding tissue. Optimization of the MRI protocol, including selection of the appropriate gadolinium-based contrast agent (GBCA), is paramount for accurate lesion imaging. GBCAs differ in their safety, tolerability, and efficacy because of their diverse physicochemical properties. [[Gadobutrol]] and [[gadobenate dimeglumine]] are high-relaxivity GBCAs that demonstrate superior efficacy for imaging metastatic lesions compared with other GBCAs, whereas gadobutrol additionally provides macrocyclic stability
((Anzalone N, Essig M, Lee SK, Dörfler A, Ganslandt O, Combs SE, Picozzi P. Optimizing contrast-enhanced magnetic resonance imaging characterization of brain metastases: relevance to stereotactic radiosurgery. Neurosurgery. 2013 May;72(5):691-701. doi: 10.1227/NEU.0b013e3182889ddf. PMID: 23381488.)).

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Most MR studies are performed with the use of contrast enhancement via intravenous injection of paramagnetic gadolinium-containing contrast media
((Kuriashkin IV, Losonsky JM. Contrast enhancement in magnetic resonance imaging using intravenous paramagnetic contrast media: a review. Vet Radiol Ultrasound. 2000 Jan-Feb;41(1):4-7. doi: 10.1111/j.1740-8261.2000.tb00419.x. PMID: 10695873.)).

Because the detection, characterization, and exact delineation of brain tumors require a high lesion contrast that depends on the signal of the lesion in relation to the surrounding tissue, contrast media is given routinely
((Essig M, Weber MA, von Tengg-Kobligk H, Knopp MV, Yuh WT, Giesel FL. Contrast-enhanced magnetic resonance imaging of central nervous system tumors: agents, mechanisms, and applications. Top Magn Reson Imaging. 2006 Apr;17(2):89-106. doi: 10.1097/01.rmr.0000245464.36148.dc. PMID: 17198225.))

Magnetic resonance imaging with contrast enhancement is the imaging procedure of choice to diagnose and characterize [[brain metastases]]. Multiple lesions with marked [[vasogenic edema]] and mass effect are typically seen in patients with brain metastases. The classical appearance of a metastases is a solid [[mass]] with [[enhancement]] with well-defined margins and extensive [[edema]]. Occasionally, central [[necrosis]] produces a ring enhancing mass.