A 55 y o female with history of altered behavior for last 1 month.
MRI Brain (Axial FLAIR, T1w, T2*GRE and PC T1w)
Multiple well circumscribed nodular masses of variable sizes in supra tentorium as well as posterior fossa with variable perilesional odema on axial FLAIR images.
Lesions are hyper intense on axial T1w images attributed to meth Hb - a sub acute stage blood degradation product, low signal intensity hemosiderin staining on axial T2*GRE images.
Most of the lesions show fluid- fluid levels due to blood sedimentation.
Axial post contrast T1w images show intense nearly homogeneous enhancement.
Imaging wise diagnosis : Multiple hemorrhagic parenchymal metastasis.
Preferred examinations are CT and MRI with contrast.
On non contrast CT hemorrhagic metastasis are high density, well circumscribed mass or masses with variable size and peri lesional edema. Hyper density in a metastasis is more likely to be hemorrhage rather than calcification.
On MRI T1 brightness is very typical suggest meth Hb - a sub acute stage blood degradation product.
MR Spectroscopy often found to be non contributory, a sub optimal spectral waveform due to incomplete water suppression and blood degradation products.
Common known primaries for hemorrhagic metastasis are melanoma, Ca thyroid Ca, renal cell Carcinoma, Choriocarcinoma etc.