Cranial computed tomography of breast carcinoma

Cranial computed tomographic (CCT) manifestations of brain metastases were reviewed in 304 patients with carcinoma of the breast. Metastases were demonstrated in 103 patients; 13 had other significant abnormalities. Single lesions were found in 55 (54%) patients (cerebral hemisphere, 48; cerebellar hemisphere, 4; pineal, 1; pituitary and optic chiasm, 1; vermis, 1) and multiple metastases were found in 48 patients. Continuity with bony metastases was seen in 4 patients. Prior to contrast infusion, 13 (12.5%) patients with metastases had a normal CCT, and 13 (12.5%) showed lesions of increased attenuation. All metastases demonstrated enhancement following contrast infusion; 74 (72%) had a zone of surrounding “edema.” Histopathologic-CCT correlation was available in 54 patients. Precontrast, increased attenuation of metastases was associated with hemorrhage or calcification, or both. Calcification accompanied by necrosis was the result of previous treatment. Following therapy, 3 patients demonstrated lesions that were impossible to differentiate from metastases by CCT, but proved histologically to have no viable tumor cells present.