Breakouts-A Radiological Sign of Poor Prognosis in Patients With Brain Metastases.

Area of Science:

• Neuro-oncology
• Radiology
• Oncologic Imaging

Background:

• Brain metastases (BM) exhibit diverse growth patterns, with infiltration at the brain parenchyma interface linked to poorer outcomes.
• Non-invasive detection of metastatic cell infiltration is crucial for tailoring treatment strategies.

Purpose of the Study:

• To identify specific magnetic resonance imaging (MRI) patterns at the macro-metastasis/brain parenchyma interface (MMPI) in patients with BM.
• To correlate these MRI patterns with patient outcomes, specifically overall survival (OS).

Main Methods:

• Retrospective analysis of a prospective BM registry involving 261 patients.
• Categorization of preoperative MRI scans into four contrast enhancement (CE) patterns: rim-enhancing, spherical, breakout, and diffuse.
• Primary outcome measured was overall survival (OS); other prognostic factors were also analyzed.

Main Results:

• Patients with a "breakout" MRI pattern demonstrated significantly worse overall survival (OS) compared to other patterns.
• The breakout pattern signifies a highly aggressive clinical course for brain metastases.

Conclusions:

• The MRI "breakout" pattern is a strong indicator of aggressive brain metastases behavior.
• Identifying this pattern may necessitate more aggressive local and systemic treatment approaches for improved patient outcomes.