Brain metastases: the role of clinical imaging

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Imaging of brain metastases (BMs) has advanced greatly over the past decade. In this review, we discuss the main challenges that BMs pose in clinical practice and describe the role of imaging.Firstly, we describe the increased incidence of BMs of different primary tumours and the rationale for screening. A challenge lies in selecting the right patients for screening: not all cancer patients develop BMs in their disease course.Secondly, we discuss the imaging techniques to detect BMs. A three-dimensional (3D) T1W MRI sequence is the golden standard for BM detection, but additional anatomical (susceptibility weighted imaging, diffusion weighted imaging), functional (perfusion MRI) and metabolic (MR spectroscopy, positron emission tomography) information can help to differentiate BMs from other intracranial aetiologies.Thirdly, we describe the role of imaging before, during and after treatment of BMs. For surgical resection, imaging is used to select surgical patients, but also to assist intraoperatively (neuronavigation, fluorescence-guided surgery, ultrasound). For treatment planning of stereotactic radiosurgery, MRI is combined with CT. For surveillance after both local and systemic therapies, conventional MRI is used. However, advanced imaging is increasingly performed to distinguish true tumour progression from pseudoprogression.FInally, future perspectives are discussed, including radiomics, new biomarkers, new endogenous contrast agents and theranostics.

Original languageEnglish
Article number20210944
Pages (from-to)20210944
Number of pages1
JournalThe British journal of radiology
Issue number1130
Early online date14 Dec 2021
Publication statusPublished - 1 Feb 2022

Bibliographical note

Funding Information:
S.D. is funded by a grant of the Daniel Den Hoed Foundation. The funding organisation is not involved in the content of this review paper.

Publisher Copyright:
© 2022 British Institute of Radiology. All rights reserved.


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