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Updated: Jul 14, 2026
Modeling Brain Metastases Through Intracranial Injection and Magnetic Resonance Imaging
Published on: June 7, 2020
Improved detection of skull metastasis with diffusion-weighted MR imaging
A J Nemeth1, J W Henson, M E Mullins
1Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
Background And Purpose:
Metastasis to the skull is clinically important, but routine MR imaging offers moderate sensitivity for skull-metastasis detection in our experience. We sought to determine if diffusion-weighted MR imaging (DWI) could improve the detection of skull metastasis in patients with primary carcinomas that metastasized to bone compared with conventional MR imaging.
Materials And Methods:
Seventy-five patients from the tumor registry of our institution with extracranial primary malignancy who had brain MR imaging with DWI and radionuclide bone scanning (RNBS, gold standard) within a 6-week interval were evaluated. Thirty-eight patients demonstrated increased radiopharmaceutical uptake on RNBS, consistent with skull metastasis of any size, and the remaining 37 were control subjects. Two readers correlated the DWI and conventional MR imaging with RNBS.
Results:
The overall sensitivity of DWI for detection of skull metastases was 68.4%-71.1% (kappa=0.68) versus 42.1%-55.3% (kappa=0.65) for conventional MR imaging. Breast cancer (n=20) was detected with greatest sensitivity of 86.7%-93.3% (kappa=0.80) for DWI versus 60%-80% (kappa=0.5) for conventional MR imaging. Lung cancer (n=32) was detected with 63.6%-72.7% sensitivity (kappa=0.56), and prostate cancer (n=8) with 14.3% sensitivity (kappa=0.5) for DWI versus 27.3%-36.4% (kappa=0.81) and 14.3-42.9% (kappa=0), respectively, for conventional MR imaging.
Conclusions:
DWI is a useful sequence for identifying focal skull metastases for breast and lung malignancies and, compared with conventional MR imaging, provides improved detection of these lesions. DWI is insensitive for detecting skull metastases from prostate carcinoma.
Insights
Diffusion-weighted MR imaging (DWI) significantly improves skull metastasis detection for breast and lung cancers compared to conventional MR imaging. However, DWI is insensitive for detecting skull metastases originating from prostate carcinoma.
Area of Science:
- Radiology
- Oncology
- Medical Imaging
Background:
- Skull metastasis detection is clinically significant.
- Conventional MR imaging has moderate sensitivity for skull metastasis.
- Diffusion-weighted MR imaging (DWI) may offer improved detection.
Purpose of the Study:
- To evaluate if DWI enhances skull metastasis detection.
- Comparison between DWI and conventional MR imaging.
- Focus on patients with primary bone-metastasizing carcinomas.
Main Methods:
- Retrospective analysis of 75 patients with extracranial malignancy.
- Comparison of DWI and conventional MR imaging against radionuclide bone scanning (RNBS) as the gold standard.
- Two readers correlated imaging findings with RNBS results.
Main Results:
- DWI sensitivity (68.4%-71.1%) surpassed conventional MR imaging (42.1%-55.3%).
- Breast cancer metastasis detection was highest with DWI (86.7%-93.3%).
- DWI showed improved sensitivity for lung cancer (63.6%-72.7%) but was insensitive for prostate cancer.
Conclusions:
- DWI is a valuable tool for detecting skull metastases from breast and lung cancers.
- DWI offers superior detection compared to conventional MR imaging for these malignancies.
- DWI is not effective for identifying skull metastases from prostate carcinoma.
