
==== Front
Neurooncol Adv
Neurooncol Adv
noa
Neuro-Oncology Advances
2632-2498
Oxford University Press US

10.1093/noajnl/vdae090.068
vdae090.068
Final Category: Neuroimaging/Radiologic Advances
AcademicSubjects/MED00300
AcademicSubjects/MED00310
NIRL-07 DIAGNOSTIC AMBIGUITIES IN MRI CHANGES IN A PATIENT WITH BRAIN METASTASES AND RECURRENT STROKES
Prakash Neal City of Hope National Medical Center, Duarte/CA, USA

Chen Bihong City of Hope National Medical Center, Duarte/CA, USA

Fricke Jeremy City of Hope National Medical Center, Duarte/CA, USA

Babikian Razmig City of Hope National Medical Center, Duarte/CA, USA

Salgia Ravi City of Hope National Medical Center, Duarte/CA, USA

8 2024
02 8 2024
02 8 2024
6 Suppl 1 2024 SNO/ASCO CNS Metastases Conference i21i21
© The Author(s) 2024. Published by Oxford University Press, the Society for Neuro-Oncology and the European Association of Neuro-Oncology.
2024
https://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

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.
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pmc
