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Updated: Apr 4, 2026
Modeling Brain Metastases Through Intracranial Injection and Magnetic Resonance Imaging
Published on: June 7, 2020
A Framework for MRI Characterization of Intracranial Metastatic Disease
Arian Lasocki1,2,3, Stefanie Catherine Thust4,5,6,7, Grant A McArthur2,8
1Department of Cancer Imaging, Peter MacCallum Cancer Centre, Grattan St, Melbourne, Victoria 3000, Australia.
Abstract:
Intracranial metastases (IM) are far more common than primary malignant brain tumors, yet remain understudied, representing an important unmet clinical need. Although patients with IM have historically been excluded from clinical trials, thus limiting assessment of intracranial treatment efficacy, their inclusion is increasing; however, patients with suspected leptomeningeal metastatic disease (LMD) remain commonly excluded, likely due to poorer prognosis and anticipated limited treatment response. Despite established treatment response criteria for confirmed LMD, there is limited guidance on how LMD should be diagnosed or excluded in broader IM trials, creating substantial risk for variability and misclassification. This article addresses the gap by proposing MRI-based criteria for classifying IM appearances with respect to LMD suspicion, focusing on the exclusion of LMD, illustrated with real patient examples. IM-related MRI findings are categorized into three groups: (a) imaging consistent with LMD, not requiring cerebrospinal spinal fluid confirmation; (b) equivocal findings warranting further evaluation with cerebrospinal fluid analysis or spinal MRI; and (c) imaging with low suspicion for LMD. Common pitfalls, mimics, and recommended next steps for equivocal findings are discussed. Keywords: Intracranial Metastasis, Leptomeningeal Metastatic Disease, MRI © RSNA, 2026.
Insights
Intracranial metastases (IM) are common, yet understudied. This study proposes MRI criteria to help exclude leptomeningeal metastatic disease (LMD) in IM trials, improving patient classification and data reliability.
Area of Science:
- Radiology
- Oncology
- Neurology
Background:
- Intracranial metastases (IM) are more prevalent than primary brain tumors but are understudied.
- Patients with IM are increasingly included in clinical trials, but those with suspected leptomeningeal metastatic disease (LMD) are often excluded due to poor prognosis.
- Lack of standardized diagnostic guidance for LMD in IM trials leads to variability and misclassification.
Purpose of the Study:
- To establish MRI-based criteria for classifying intracranial metastasis (IM) appearances concerning leptomeningeal metastatic disease (LMD) suspicion.
- To provide guidance for excluding LMD in broader IM clinical trials.
- To reduce variability and misclassification in diagnosing LMD within IM cohorts.
Main Methods:
- Development of MRI-based criteria for categorizing IM findings related to LMD suspicion.
- Categorization into three groups: imaging consistent with LMD, equivocal findings, and low suspicion for LMD.
- Inclusion of patient examples to illustrate MRI findings and classification.
Main Results:
- Proposed MRI criteria allow for classification of IM findings regarding LMD suspicion.
- Categorization aids in determining the need for further evaluation (e.g., CSF analysis, spinal MRI) or exclusion of LMD.
- Discussion of common pitfalls, mimics, and recommended management for equivocal findings.
Conclusions:
- Standardized MRI criteria can improve the classification and exclusion of LMD in IM trials.
- This approach addresses an unmet clinical need by enhancing diagnostic accuracy.
- Facilitates more reliable assessment of intracranial treatment efficacy in patients with IM.
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