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Web End = J Neurooncol (2016) 127:589595 DOI 10.1007/s11060-016-2069-1
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Web End = Comet tail sign: A pitfall of post-gadolinium magnetic resonance imaging ndings for metastatic brain tumors
Koichi Mitsuya1 Yoko Nakasu1 Yoshitaka Narita4
Satoshi Nakasu5 Makoto Ohno4 Yasuji Miyakita4
Masato Abe2 Ichiro Ito2 Nakamasa Hayashi1 Masahiro Endo3
Received: 22 July 2015 / Accepted: 26 January 2016 / Published online: 2 February 2016 The Author(s) 2016. This article is published with open access at Springerlink.com
Abstract A highly enhanced cap attached to the surface of metastatic tumors in the brain parenchyma is occasionally encountered on magnetic resonance (MR) images. This atypical enhanced cap tends to occur in severe peritumoral edema and may produce the characteristic bulge of a meta-static mass lesion termed the comet tail sign (CTS). The purpose of this study was to demonstrate the features of the CTS using MR imaging and pathological ndings, and to clarify its clinical relevance. We selected 21 consecutive cases of newly diagnosed metastases from MR imaging studies that demonstrated the CTS; all had diffuse peritumoral edema. The MR T2-weighted images showed similarly homogenous and high intensity signals in both the tail and peritumoral edema. Fourteen of the 21 patients underwent surgical resection of their tumors, and 12 tails were separately removed for pathological examination, no tumor cells which revealed. We speculate that the CTS does not contain neoplastic tissues but is observed as a result of the leakage of contrast medium from the tumor body into the interstitial space of the white matter. Although CTS is a peculiar and uncommon enhancement pattern, it has clinical signicance in determining the extent of
the margin for invasive local treatments, such as surgical resection or stereotactic radiotherapy; this is particularly true in and near the eloquent areas.
Keywords Atypical enhancement pattern
Extravasation Gadolinium Magnetic resonance imaging
Metastatic brain tumor
Introduction
Metastatic brain tumors occur in 8.540 % of patients with systemic cancers [1, 2]. Recent advances in the systemic management of cancer patients and novel imaging techniques have led to an increase in the number...