Skip to main content
SpringerLink
Log in

Clinical Presentations, Differential Diagnosis, and Imaging Workup of Cerebral Mass Lesions

  • Living reference work entry
  • Latest version View entry history
  • First Online:
Clinical Neuroradiology

  • 97 Accesses

Abstract

A brain mass lesion can have a myriad of etiologies and may present acutely or be of insidious onset. Symptoms are related to the lesion location, degree of tissue swelling, and rapidity of its onset. Neoplasms can arise from a variety of structures, including glial and neuronal cells, the meninges, ventricular elements, and gland tissue; furthermore, a number of somatic metastases may spread to the brain. Clinical neuroradiology plays an important role by considering nonneoplastic space occupying brain lesions, ranging from infectious processes (encephalitis, cerebritis, cerebral abscess) to tumefactive demyelination, vascular (arterial and venous infarction), autoimmune (sarcoidosis, Ig4 disease, vasculitis), toxic-metabolic and transient (e.g., postictal swelling) conditions. Tumor mimics are often, but not always identifiable through pattern recognition, using a combination of structural MR imaging sequences and advanced techniques, including follow-up radiological techniques where appropriate.

Advanced imaging techniques can provide physiological and quantifiable data to aid the distinction of nonneoplastic.

This publication is endorsed by: European Society of Neuroradiology (www.esnr.org)

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

Abbreviations

[11C] Choline:

Carbon-11-choline

[18F]choline:

8F-fluorinated choline

[18F]FDG:

Fluorodeoxyglucose F 18

3D:

Volumetric

68Ga-DOTATOC:

68Gallium-DOTA-Tyr3-octreotide

ACRIN:

American College of Radiology Imaging Network

ADC:

Apparent diffusion coefficient

APT:

Amide proton transfer

ASL:

Arterial spin labeling

BOLD:

Blood oxygen level-dependent

CEST:

Chemical exchange saturation transfer

Cho:

Choline

CNS:

Classification of central nervous system

Cr:

Creatine

CSF:

Cerebrospinal fluid

CT:

Computed tomography

DCE:

Dynamic contrast enhanced

DOTA:

1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid

DSC:

Dynamic susceptibility contrast

DTI:

Diffusion tensor imaging

DWI:

Diffusion-weighted imaging

EORTC:

European Organisation for Research and Treatment of Cancer

FDOPA:

[18F]-dihydroxyphenylalanine

FET:

[18F]-fluoroethyl-L-tyrosine

FLAIR:

Fluid-attenuated inversion recovery

fMRI:

Functional MRI

Gad:

Gadolinium

Glx:

Glutamate/glutamine

HIV:

Human immunodeficiency viruses

ITSS:

Intratumoral susceptibility signal

Ktrans:

Transfer coefficient

MET:

[11C]-methionine

MI:

Myoinositol

MRI:

Magnetic resonance imaging

MRS:

MR spectroscopy

NAA:

N-acetyl aspartate

NBTS:

The United States National Brain Tumor Society

PCNSL:

Primary central nervous system lymphoma

PET:

Positron-emission tomography

PNET:

Primitive neuroectodermal tumor

ppm:

Parts per million

PWI:

Perfusion-weighted MRI

PXA:

Pleomorphic xanthoastrocytoma

QUIBA:

Quantitative Biomarkers Alliance

rCBF:

Relative cerebral blood flow

rCBV:

Relative cerebral blood volume

T1w:

T1-weighted images

T2w:

T2-weighted images

TE:

Echo time

TNM:

Tumor, node, metastasis

Ve:

Extravascular extracellular space

Vp:

Plasma volume

WHO:

World Health Organization

References

  • Berzero G, Di Stefano AL, Ronchi S, Bielle F, Villa C, Guillerm E, Capelle L, Mathon B, Laurenge A, Giry M, Schmitt Y, Marie Y, Idbaih A, Hoang-Xuan K, Delattre JY, Mokhtari K, Sanson M. IDH-wildtype lower-grade diffuse gliomas: the importance of histological grade and molecular assessment for prognostic stratification. Neuro-Oncology. 2021;23(6):955–66. https://doi.org/10.1093/neuonc/noaa258.

  • Clarke C, Howard R, Rossor M, Shorvon S, editors. Neurology: a Queen square textbook. 2nd ed. Wiley Blackwell; 2016.

    Google Scholar 

  • Comelli I, Lippi G, Campana V, Servadei F, Cervellin G. Clinical presentation and epidemiology of brain tumors firstly diagnosed in adults in the emergency department: a 10-year, single center retrospective study. Ann Trans Med. 2017;5(13):269.

    Article  Google Scholar 

  • Crocetti E, Trama A, Stiller C, Caldarella A, Soffietti R, Jaal J, et al. RARECARE working group. Epidemiology of glial and non-glial brain tumours in Europe. Eur J Cancer. 2012;48(10):1532–42. https://doi.org/10.1016/j.ejca.2011.12.013. Epub 2012 Jan

    Article  PubMed  Google Scholar 

  • Ellingson B, Bendszus M, Boxerman J, Barboriak D, Erickson BJ, Smits M, et al. Consensus recommendations for a standardized brain tumor imaging protocol in clinical trials. Neuro-Oncology. 2015;17(9):1188–98. https://doi.org/10.1093/neuonc/nov095. Epub 2015 Aug 5

    Article  PubMed  PubMed Central  Google Scholar 

  • Kwak HS, Hwang S, Chung GH, Song JS, Choi EJ. Detection of small brain metastases at 3 T: comparing the diagnostic performances of contrast-enhanced T1-weighted SPACE, MPRAGE, and 2D FLASH imaging. Clin Imaging. 2015;39:571–5. https://doi.org/10.1016/j.clinimag.2015.02.010.

    Article  PubMed  Google Scholar 

  • Louis DN, Perry A, Wesseling P, Brat DJ, Cree AI, Figarella-Branger D, et al. The 2021 WHO classification of tumors of the central nervous system: a summary. Neuro-Oncology. 2021;23(8):1231–51.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Nunes RH, Hsu CC, da Rocha AJ, do Amaral LLF, Godoy LFS, Waltkins TW. Multinodular vacuolating glioneuronal tumor of the cerebrum: a new “leave me alone” lesion with a characteristic imaging pattern. AJNR Am J Neuroradiol. 2017;38(10):1899–904. https://doi.org/10.3174/ajnr.A5281. Epub 2017 Jul 13

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Osborn AG, Salzman KL, Jhaveri MD, Barkovich AJ. Diagnostic brain. 3rd ed. Elsevier; 2016.

    Google Scholar 

  • Thom M, Liu J, Bongaarts A, Reinten RJ, Paradiso B, Jäger HR, Reeves C, Somani A, An S, Marsdon D, McEvoy A, Miserocchi A, Thorne L, Newman F, Bucur S, Honavar M, Jacques T, Aronica E. Multinodular and vacuolating tumors in epilepsy: dysplasia or neoplasia? Brain Pathol. 2018;28(2):155–71.

    Article  CAS  PubMed  Google Scholar 

  • Thust SC, Heiland S, Falini A, Jäger HR, Waldman AD, Sundgren PC, Godi C, Katsaros VK, Ramos A, Bargallo N, Vernooij MW, Yousry T, Bendszus M, Smits M. Glioma imaging in Europe: a survey of 220 centres and recommendations for best clinical practice. Eur Radiol. 2018;28(8):3306–17.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Verburg N, Hoefnagels FWA, Barkhof F, Boellaard R, Goldman S, Guo J, Heimans JJ, Hoekstra OS, Jain R, Kinoshita M, Pouwels PJW, Price SJ, Reijneveld JC, Stadlbauer A, Vandertop WP, Wesseling P, Zwinderman AH, De Witt Hamer PC. Diagnostic accuracy of neuroimaging to delineate diffuse gliomas within the brain: a meta-analysis. AJNR Am J Neuroradiol. 2017;38(10):1884–91.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Welker K, Boxerman J, Kalnin A, Kaufmann T, Shiroshi M, Wintermark M. ASFNR recommendations for clinical performance of MR dynamic susceptibility contrast perfusion imaging of the brain. AJNR Am J Neuroradiol. 2015;36(6):E41–51.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Further Reading

Download references

Author information

Authors and Affiliations

  1. Department of Engineering for Innovation Medicine, Verona University, Verona, Italy

    Francesca Benedetta Pizzini

  2. Precision Imaging Beacon, School of Medicine, University of Nottingham, Nottingham, UK

    Stefanie Thust

  3. Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK

    Stefanie Thust

  4. Department of Brain Rehabilitation and Repair, Institute of Neurology, University College London, London, UK

    Stefanie Thust & Rolf Jäger

  5. Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK

    Rolf Jäger

  6. Imaging Department, University College London Hospital, London, UK

    Rolf Jäger

Authors
  1. Francesca Benedetta Pizzini
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stefanie Thust
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rolf Jäger
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rolf Jäger .

Editor information

Editors and Affiliations

  1. Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands

    Frederik Barkhof

  2. National Hosp.f Neurology & Neurosurgery, UCL National Hosp.f Neurology & Neurosurgery, London, UK

    Rolf Jager

  3. Division of Neuroradiology, University Hospital Vienna Division of Neuroradiology, Wien, Austria

    Majda Thurnher

  4. Department of Neuroradiology, Hospital Vall d’Hebrón Department of Neuroradiology, Barcelona, Spain

    Alex Rovira Cañellas

Section Editor information

  1. UCL Institute of Neurology, The National Hospital for Neurology and Neurosurgery and University College Hospital (UCH), London, UK

    Hans Rolf Jäger

Rights and permissions

Reprints and permissions

Copyright information

© 2023 Springer Nature Switzerland AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Pizzini, F.B., Thust, S., Jäger, R. (2023). Clinical Presentations, Differential Diagnosis, and Imaging Workup of Cerebral Mass Lesions. In: Barkhof, F., Jager, R., Thurnher, M., Rovira Cañellas, A. (eds) Clinical Neuroradiology. Springer, Cham. https://doi.org/10.1007/978-3-319-61423-6_56-2

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-61423-6_56-2

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-61423-6

  • Online ISBN: 978-3-319-61423-6

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics

Chapter history

  1. Latest

    Clinical Presentations, Differential Diagnosis, and Imaging Workup of Cerebral Mass Lesions
    Published:
    27 September 2023

    DOI: https://doi.org/10.1007/978-3-319-61423-6_56-2

  2. Original

    Clinical Presentations, Differential Diagnosis, and Imaging Work-Up of Cerebral Mass Lesions
    Published:
    11 April 2019

    DOI: https://doi.org/10.1007/978-3-319-61423-6_56-1

Societies and partnerships

Search

Navigation