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Imaging of brain metastasis in non-small-cell lung cancer: indications, protocols, diagnosis, post-therapy imaging,
N Chakrabarty1, A Mahajan1, V Patil2
1Department of Radiodiagnosis, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, 400 012, Maharashtra, India.
Abstract:
Increased survival (due to the use of targeted therapies based on genomic profiling) has resulted in the increased incidence of brain metastasis during the course of disease, and thus, made it essential to have proper imaging guidelines in place for brain metastasis from non-small-cell lung cancer (NSCLC). Brain parenchymal metastases can have varied imaging appearances, and it is pertinent to be aware of the various molecular risk factors for brain metastasis from NSCLC along with their suggestive imaging appearances, so as to identify them early. Leptomeningeal metastasis requires additional imaging of the spine and an early cerebrospinal fluid (CSF) analysis. Differentiation of post-therapy change from recurrence on imaging has a bearing on the management, hence the need for its awareness. This article will provide in-depth literature review of the epidemiology, aetiopathogenesis, screening, detection, diagnosis, post-therapy imaging, and implications regarding the management of brain metastasis from NSCLC. In addition, we will also briefly highlight the role of artificial intelligence (AI) in brain metastasis screening.
Insights
Improved survival from targeted therapies for non-small cell lung cancer (NSCLC) increases brain metastasis. Early identification through awareness of molecular risk factors and imaging appearances is crucial for effective management.
Area of Science:
- Oncology
- Radiology
- Genomics
Background:
- Advances in targeted therapies for non-small cell lung cancer (NSCLC) have improved patient survival.
- Increased survival has led to a higher incidence of brain metastasis as a late-stage complication.
- Current imaging guidelines for brain metastasis from NSCLC require updates to address this trend.
Purpose of the Study:
- To review the epidemiology, pathogenesis, and diagnostic imaging of brain metastasis in NSCLC.
- To highlight the importance of recognizing varied imaging appearances associated with molecular risk factors.
- To discuss the differentiation of post-therapy changes from recurrence and the role of AI in screening.
Main Methods:
- Comprehensive literature review on brain metastasis from NSCLC.
- Analysis of imaging appearances related to molecular subtypes and risk factors.
- Discussion of diagnostic modalities including MRI, spine imaging, and CSF analysis.
Main Results:
- Brain parenchymal metastases present with diverse imaging characteristics.
- Specific molecular factors in NSCLC correlate with increased risk and suggestive imaging findings.
- Distinguishing treatment effects from tumor recurrence on imaging is critical for patient management.
Conclusions:
- Awareness of imaging appearances linked to molecular risk factors is essential for early detection of brain metastasis in NSCLC.
- Standardized imaging guidelines are needed to manage the rising incidence of brain metastasis.
- Artificial intelligence may play a future role in enhancing screening and diagnosis.
