Perfusion MR Imaging of an Intracranial Collision Tumor Confirmed by Image-Guided Biopsy
P. Juna,
J. Garciab,
T. Tihanb,
M.W. McDermottc and
S. Chaa,c
a Department of Radiology, University of California, San Francisco, Calif
b Department of Pathology, University of California, San Francisco, Calif
c Department of Neurological Surgery, University of California, San Francisco, Calif
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Fig 1. Images of a 56-year-old woman with a history of breast carcinoma presenting with 2 weeks of headache, nausea, and vomiting. Image-guided open biopsy demonstrated a collision tumor between a typical meningioma and metastatic breast carcinoma.
A, Axial fluid-attenuated inversion recovery (10,000/148/2,200 milliseconds [TR/TE/TI]) image. A heterogeneously intense, right anterior frontal bilobed mass (straight arrows) is seen with surrounding edema and hemorrhage (curved arrows).
B, Axial postcontrast spoiled gradient-recalled (SPGR; 34/8) T1-weighted image. The mass demonstrates uniform contrast enhancement with a posterior rim of hemorrhage (curved arrows).
C, Perfusion MR color map overlaid onto the corresponding axial postcontrast section. Relative cerebral blood volume is increased within the bilobed enhancing lesion. Two regions of interest, labeled 1 and 2, are defined on the anterior and posterior lobes of the tumor.
D, T2* susceptibility signal intensity-time curves. The anterior (1) and posterior (2) lobes demonstrate differences in the degree of signal intensity drop and pattern of signal intensity recovery.
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Fig 2. Intraoperative screen captures from the StealthStation neuronavigation system. The anterior lobe, corresponding to region of interest 1, is targeted for image-guided open biopsy.
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Fig 3. Histopathologic sections from the anterior and posterior lobes corresponding to regions of interest 1 and 2, respectively.
A, Anterior biopsy shows hyperchromatic tumor cells arranged in sheets consistent for a typical meningioma (hematoxylin-eosin, magnification x200).
B, Posterior biopsy demonstrates pleomorphic tumor cells arranged in attenuated clusters with pseudoglandular formation. This is histologically identical to the patient’s prior breast carcinoma (hematoxylin-eosin, magnification x200).
C, Section through the resected tumor reveals the interface between the typical meningioma and metastatic breast carcinoma (hematoxylin-eosin, magnification x40).
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