The Adelaide MR Web Site
MR Spectroscopy Case Study
 Cerebral Adenocarcinoma Metastasis
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Prepared by Greg Brown    Royal Adelaide Hospital North Terrace Adelaide South Australia 5000 Back to MRS Page

Images and Spectra obtained on a Siemens VISION 1.5T using Numairs VB33E software.  Images and Spectra converted to JPEG files using eFilm.

Presentation Imaging MRS Results MRS Technique Histopathology Discussion

Presentation
(EG) Sudden onset of weakness. Colon andenocarcinoma resected 2 years ago with secondary to kidney resected 1 week ago.

Imaging
CT Solitary lesion Rt fronto-parietal with oedema
MR 13/11/00 MR scan for brain biopsy guidance. MRS performed incidentally.  3 x 3 x 3.5 cm mass with central cystic portion.  Mild enhancement of thick wall, prominent oedema with focal mass effect..  Conclusion: Lymphoma or metastasis from known renal cell carcinoma
"Spectroscopy demonstrates some elevation of Choline with reduction of NAA, consistent with infiltrating lesion."

MRS Technique
 8 cc voxel. SVS SE135, SVS STEAM 10,  SVS STEAM 20 in the lesion.  Voxel contains <20% normal brain

MRS Results
 
SVS SE135 SE135
Markedly elevated Choline. Minimal NAA. huge broad peak at 1.3ppm and broad peak at 0.9ppm.  Good spectral resolution evidenced by teh Choline Creatine separation
STEAM 10
The lipid peaks as the short TE doesn't allow for signal loss due to lipid's short T2.
A broad lobe oblites NAA with a suggestion of elevation at 3.3ppm that is presumably Choline or Taurine. The scaling of the Y axis by teh lipid peak makes teh baseline look quite smooth, so to evaluate the other metabolites the spectrum needs to be rescaled to give a max Y value of about 40.
No inverting signals in the 1.3 location so I am presuming no sign of Lactate.
 
SVS STEAM 20 STEAM 20
Lipid signals still over shadow all other meatbolites


Histopathology
Colon AdenoCarcinoma resected 2 years ago.  Renal Secondary resected 1 week ago.
Lesion excised 10 x 10 x 5 mm.   Moderately differentiated metestatic adenocarcinoma, consistent with a colonic primary.
Microscopic examination showed extensive necrosis. Tunour cells are predominately columnar containing mucin.  Appearances weresimilar to the histology of the resected colonic tumour

Discussion
The radiology report suggesting lymphoma or a secondary from the renal tumour , relied on incomplete infromation about the nature of the renal mass. To date we have only observed the strong lipids in carcinoma metastases.
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