Workup/Staging

Question 1

Describe the workup of a brain met.

Answer 1

Brain met workup: H&P focus on characterization of any neurologic Sx, evaluation for infectious causes (fever, CBC), careful neurologic exam, MRI brain +/– gadolinium, assessment for status of extracranial Dz, determination of KPS, and neurosurgery consult

Question 2

What is the DDx for a new lesion in the brain?

Answer 2

Brain lesion DDx: mets, infection/abscess, hemorrhage, primary brain tumor, infarct, tumefactive demyelinating lesion, and RT necrosis

Question 3

What imaging features are suggestive of brain mets?

Answer 3

Imaging features suggestive of brain mets include lesions at gray/white matter junction, multiple lesions, ring-enhancing lesions, and significant vasogenic edema

Question 4

What is triple-dose gadolinium, and why is it used?

Answer 4

Triple-dose gadolinium: 0.3 mmol/kg. It is used to increase the sensitivity of MRI.