Presentation
Persistent headaches in a patient known for hepatocellular carcinoma (HCC) on follow-up.
Patient Data
There are two intra-axial parietal lesions at the white-grey matter junction of the right parasagittal and left postcentral location with surrounding vasogenic edema. They elicit an iso signal to the cortical grey matter on T1 and T2 and iso-to-high signal FLAIR with areas of high signal on T1 and low signal on T2 and GE sequences (hemorrhage). The post-contrast sequence demonstrates heterogeneous and peripheral ring enhancement. Facilitated diffusion is noted in the surrounding edema on the ADC.
The MRS demonstrates a choline peak with depleted NAA and lipid peak.
Small vessel ischemic change is noted.
Case Discussion
The MRI features of multiple enhancing intra-axial lesions with surrounding vasogenic edema in a patient treated for hepatocellular carcinoma (HCC) are most consistent with brain metastases.
Brain metastases from hepatocellular carcinoma (HCC) are extremely rare, with an incidence from 0.2% to 2.2%. Usually occur in patients with advanced liver disease and distant extracerebral metastases (lung, bone, adrenal glands, lymph nodes) 1,2.
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