MAGNETIC RESONANCE IMAGING FEATURES OF CANINE

INTRACRANIAL NEOPLASIA

ERIK R. WISNER, PETER J. DICKINSON, ROBERT J. HIGGINS

Although histologic examination following stereotactic or surgical brain biopsy is required for definitive an-
temortem diagnosis of intracranial neoplasms, these tumors are often associated with magnetic resonance (MR)
imaging features that warrant a presumptive or prioritized differential diagnosis. The MR imaging features of
common canine central nervous system (CNS), adenohypophyseal, and metastatic intracranial neoplasms are
reviewed. Characterization of neoplasms by histologic type and biological grade is based on the 2007 World
Health Organization classification system for CNS tumors in humans. r 2011 Veterinary Radiology &
Ultrasound, Vol. 52, No. 1, Supp. 1, 2011, pp S52–S61.

Key words: brain biopsy, brain tumor, dog, intracranial neoplasia, magnetic resonance imaging.

Tumor Diagnosis and Classification MR Imaging Features of Common Canine Brain Tumors

H ISTOLOGIC EXAMINATION IS required for definitive an-

temortem diagnosis of intracranial neoplasms; how-
ever, biopsy of intracranial lesions is challenging.
The MR imaging characteristics of relatively few canine
CNS neoplasms have been comprehensively reported, hence
many of the following descriptions are based on our com-
Stereotactic brain biopsy, first reported in dogs in 1999, bined years of clinical experience with histologically confirmed
is the optimal technique, but it has become routine in only intracranial tumors. Diagnostic criteria for canine CNS neo-
a few veterinary institutions and practices.1–5 As a result, plasms can be expected to become more refined as further
the magnetic resonance (MR) imaging features of intra- studies are done and MR techniques continue to develop.
cranial lesions are often used as the basis for presumptive Intracranial tumors may be classified by anatomic loca-
or prioritized differential diagnosis before, or instead of, tion (supratentorial, subtentorial, basilar, etc.), by distribu-
biopsy. Here we review the MR imaging features of the tion (intraaxial, intraventricular, extraaxial), intratumoral
most common canine primary and metastatic intracranial MR signal characteristics (hyperintense, hypointense, sus-
tumors and some feline tumors. ceptibility effect) (by convention, the terms hypo-, hyper- and
A current, definitive histologic classification scheme for isointense describe signal intensity relative to that of normal
nervous system tumors of domestic animals is lacking. In- gray matter in the same image) by contrast enhancement
stead of the 1999 World Health Organization (WHO) clas- characteristics (non-, uniformly, or peripherally enhancing,
sification system for domestic animals, this review uses the etc.), tumor margin definition, mass effect (midline shift,
current 2007 WHO classification scheme for central ner- sulcal and gyral effacement, ventricular distortion), and the
vous system (CNS) tumors in humans because it includes extent of brain edema. Brain edema associated with intra-
comparable tumors and well-defined criteria for histologic cranial tumors is usually vasogenic edema, which occurs due
grading not found in the 1999 version for domestic animals to increased vascular permeability and preferentially distrib-
although it also includes many entities that are rare or not utes in the peritumoral extracellular space of white matter.
yet recognized in veterinary medicine.6,7 Adenohypophy- Less commonly, intracellular cytotoxic edema may occur
seal tumors are excluded from the WHO listing of CNS from cell hypoxia or interstitial edema can occur as a result
tumors, but are included here because they must be dis- of hydrostatic forces associated with obstructive hydroceph-
tinguished clinically from other intracranial neoplasms. In alus. For this review, minimal edema is defined as restricted
contrast, nasal tumors and primary neoplasms of the skull to the tumor or immediate peritumoral tissue, moderate
(osteosarcoma, multilobular tumor) are excluded (Table 1). edema is defined as regional but extending well beyond
tumor margins, and marked edema is defined as being hemi-
spheric or nearly so.
From the Department of Surgical and Radiological Sciences, School of
Veterinary Medicine (Wisner, Dickinson), and Department of Pathology,
Microbiology, and Immunology (Higgins), University of California, Tumors of Neuroepithelial Origin
Davis, Davis, CA 95616.
Address correspondence and reprint requests to Erik R. Wisner, at the Astrocytoma
above address. E-mail: [email protected]
Received July 23, 2010; accepted for publication October 11, 2010. Astrocytomas are the most common of the intraaxial
doi: 10.1111/j.1740-8261.2010.01785.x CNS neoplasms.8 Although the precise origin of glial

S52
Vol. 52, No. 1, Supplement 1 MR IMAGING OF INTRACRANIAL NEOPLASIA S53

Table 1. Classification of Intracranial Neoplasms Astrocytomas may be spherical or irregular in shape.

Tumors of neuroepithelial origin
They typically appear mildly to moderately hypointense in
Astrocytic unenhanced T1-weighted (T1W) images and moderately
Oligodendroglial hyperintense in T2-weighted (T2W) images. Peritumoral
Oligoastrocytic
Ependymal
edema is variable but usually minimal to moderate. Int-
Choroid plexus ratumoral hemorrhage may also be evident in high-grade
Other neuroepithelial tumors. The degree of enhancement after gadolinium
Neuronal and mixed neuroglial
Pineal region
administration reflects microvascular proliferation and
Embryonal blood–brain barrier disruption, and tends to increase with
Tumors of cranial and paraspinal nerves astrocytoma grade: low grade astrocytomas typically do not
Schwannoma
Neurofibroma
enhance or enhance minimally whereas Grades III and IV
Perineuroma astrocytomas are more likely to show moderate or marked,
Malignant peripheral nerve sheath tumor nonuniform, or peripheral contrast enhancement though
Tumors of the meninges
Tumors of meningoepithelial cells (meningioma)
exceptions occur (Fig. 1).8,9,13–15
Mesenchymal tumors
Primary melanocytic lesions
Other neoplasms related to the meninges Oligodendroglioma
Lymphomas and hematopoietic tumors
Lymphoma Oligodendrogliomas appear to arise from the oligo-
Plasmacytoma dendrocytic population occurring with similar frequency to
Histiocytic tumors
Germ cell tumors
astrocytomas and, like astrocytomas, affect older dogs,
Tumors of the sellar region particularly Boxers and other brachycephalic breeds.8
Pituitary adenoma, adenocarcinomaw Oligodendrogliomas most frequently arise supratentori-
Craniopharyngioma
Granular cell tumors
ally in the frontal, piriform, and temporal lobes of the
Teratoma cerebrum and, less commonly, more caudally.
Metastatic tumors of the central nervous system Canine oligodendrogliomas are considered either low-
This table is modified from the WHO classification of tumors of the grade (Grades I or II) or high-grade (Grade III), with Grade
central nervous system updated in 2007.7
III tumors greatly predominating. Oligodendrogliomas
wPituitary adenomas and adenocarcinomas are not included in the typically have a central mucinous content that contributes
WHO classification scheme of central nervous system tumors since they to marked hyperintensity in water-sensitive MR images.
arise from the adenohypophysis.WHO, World Health Organisation. Peripherally, low-grade oligodendrogliomas have a well-
differentiated cell population and a well-defined interface
with adjacent brain parenchyma while the high-grade
tumors is not determined, astrocytomas have characteris- oligodendrogliomas are composed of more anaplastic cells
tics similar to the astrocytic glial cell population. Boxers with necrosis and microvascular proliferation. As with
and some other brachycephalic breeds are highly predis- astrocytomas, microvascular proliferation is associated with
posed. Older dogs are most frequently affected, but peripheral or nonuniform contrast enhancement.16 Tumor-
astrocytomas also occur in young animals.9 Although as- related production of vascular permeability factors such as
trocytomas can originate from either white or gray matter, vascular endothelial growth factor may also contribute to
those that occur within the cerebrum appear to arise pre- contrast enhancement in high-grade oligodendrogliomas and
dominantly from white matter.10,11 The frontal, piriform, astrocytomas.17
and temporal lobes are the most common sites. Oligodendrogliomas may be globular or irregularly
The human WHO 2007 histological classification scheme shaped and are moderately hypointense in unenhanced
grades astrocytomas based on strict cytological character- T1W images and markedly hyperintense in T2W images
istics. Grades I and II astrocytomas (diffuse astrocytomas) when there is significant mucinous content. Peritumoral
are considered the least malignant forms and consist of a edema typically ranges from minimal to moderate; even
uniform, well-differentiated infiltrative cell population large oligodendrogliomas may induce minimal edema.
without mitotic activity. Grade III (anaplastic) astrocyto- Contrast enhancement of oligodendrogliomas is highly
mas have more nuclear atypia, a much higher cell density variable ranging from none to intense and peripheral
and mitotic activity. Grade IV astrocytomas (glioblastoma or nonuniform. Focal or regional contrast enhancement is
multiforme) are the most malignant and infiltrative, often distributed centrally or eccentrically within the
frequently having regions of necrosis, microvascular pro- greater tumor volume and may have a serpentine shape.
liferation, and sometimes intratumoral hemorrhage that Intratumoral hemorrhage may also be evident (Fig. 1). MR
contribute heterogeneity to their MR imaging appearance imaging features of oligodendrogliomas do not correlate
in both humans and animals.12 well with the WHO tumor grade.8,15,16
S54 WISNER, DICKINSON, AND HIGGINS 2011

Fig. 1. Grade II astrocytoma involving the left side of the cerebellum. The mass is ill defined with T2-weighted (T2W) hyperintensity (A), T1-weighted
(T1W) hypointensity (B), and no contrast enhancement (C). (D–F) Grade IV astrocytoma (glioblastoma multiforme) involving the left temporal and piriform
lobes. This mass is also ill defined with T2W hyperintensity (D), T1W hypointensity (E), mixed signal intensity centrally indicative of diffuse intratumoral
hemorrhage (D,E). The mass is nonuniformly enhancing but enhances intensely peripherally (F). The moderate volume of peritumoral edema seen in (D)
extends well beyond the tumor margins defined in (F). (G–I) Grade III oligodendroglioma involving the right cerebral hemisphere. This mass is well delineated
with marked T2W hyperintensity (G) and pronounced T1W hypointensity (H) consistent with the high water content of the mucinous component of this tumor.
The mass is intensely peripherally contrast enhancing (1). Given the size of this tumor, there is surprisingly little peritumoral edema (G).

Mixed Glial Cell Tumors or they may contain a combination of astrocytic and
oligodendrocytic subpopulations. Our experience suggests
Canine mixed glial tumors are usually comprised of tu- these tumors have MR imaging features similar to
mor cells with both astrocytic and oligodendrocytic features astrocytomas and oligodendrogliomas.
Vol. 52, No. 1, Supplement 1 MR IMAGING OF INTRACRANIAL NEOPLASIA S55

Ependymal Tumors underlying papillary vascular architecture of these tumors

(Fig. 2). Intraventricular and intrathecal ‘‘drop metastases’’
Ependymomas are relatively rare tumors that arise from
may appear as intensely contrast enhancing foci. CPP and
the ependymal lining cells of the ventricular system and
CPC cannot be reliably distinguished by MR imaging, al-
thus may occur within the ventricular system of the brain
though presence of drop metastases suggests CPC.8,15,20–24
and spinal cord. These tumors are predominantly intra-
ventricular, although some invade the adjacent brain
parenchyma, and they expand to fill the ventricular cav-
ity in which they arise, causing distortion of the ventricle Tumors of the Meninges
and obstructive hydrocephalus, depending on their size and Meningioma
location. Ependymomas may be well differentiated (WHO
Meningiomas are the most common of the primary
Grade II) or anaplastic and aggressive (WHO Grade III).
intracranial, extraaxial neoplasms in dogs and cats. German
Grossly, the tumors can be soft, lobular (papillary type), or
Shepherd dogs, Collies, Golden Retrievers, and Boxer dogs
solid (cellular subtype) and may contain cysts and/or hem-
appear to be overrepresented.10,11 Meningiomas are derived
orrhage.10,11 Ependymomas usually affect older dogs and
from meningothelial cells, are well-characterized histological-
cats without any breed predisposition.
ly, and are divided into three grades: WHO Grade I, benign;
Ependymomas appear slightly hypointense to slightly
WHO Grade II (atypical) that have intermediate histologic
hyperintense in T1W images and moderately to markedly
features; and WHO Grade III, malignant. Of 112 canine
hyperintense in T2W images. Ependymomas may be
meningiomas, 56% were classified as Grade I, 43% were
accommodated by gradual ventricular dilation, hence edema
classified as Grade II, and o1% were classified as Grade
is usually absent or minimal unless the tumor invades the
III.25 In veterinary medicine, the value of such grading, from
periventricular brain parenchyma or hydrocephalus causes
a prognostic and therapeutic standpoint, is not yet clear.
periventricular interstitial edema. Contrast enhancement
Meningiomas in dogs are most frequently observed im-
tends to be marked and may be heterogeneous, which re-
pinging on the olfactory bulbs and frontal lobes, particularly
flects the coarse texture of the tumor parenchyma.15,18,19
a macrocystic histological subtype of the tumor. The re-
Heterogeneity may be even more pronounced when cysts or
mainder are located in the cerebral or cerebellar convexity,
hemorrhage are present.
or are cerebellopontine, basilar, tentorial, falcine, foraminal,
or intraventricular.25 Multiple meningiomas of varying size
Choroid Plexus Tumors (CPT) and location may be present simultaneously, particularly in
older cats, and it is unclear whether these represent true
CPT are relatively common neoplasms that arise from multicentric disease or metastasis.26–28
the choroid plexus epithelium within lateral, third and Meningiomas are usually uniformly isointense in T1W
fourth ventricles and the lateral apertures; about 50% images but are occasionally hypo- or hyperintense.
originate in the fourth ventricle or lateral apertures. The Approximately 70% of meningiomas are hyperintense in
average age of dogs at diagnosis is 6 years, which is earlier T2W images with the remainder being isointense. Despite
than most other intracranial tumors. Golden Retrievers the relatively benign biological behavior of many of these
appear to be highly overrepresented.20 Classification of tumors, about 95% of meningiomas are accompanied by
canine CPT distinguishes choroid plexus papillomas (CPP, edema, which may be peritumoral (40%) or diffuse
comparable to WHO Grade I), which are morphologically (50%).25 Edema seen in T2W or fluid-attenuated inver-
benign, from choroid plexus carcinomas (CPC, compara- sion recovery images often clearly delineates the internal
ble to WHO Grade III), which are histologically more margin of a meningioma, which aids recognition of its ex-
abnormal and more likely to invade the brain or give rise to traaxial origin. Approximately 60–70% of meningiomas
intraventricular or intrathecal metastases.20 show marked uniform contrast enhancement with the re-
CPT share many MR imaging features with ependymo- mainder being more heterogeneous. Contrast enhancement
mas. Initially, they may conform to the shape of the usually reveals well-defined tumor margins, globoid,
ventricle in which they grow, but enlargement may lead to plaque-like or irregular shape, and a broad-based external
hydrocephalus because of ventricular obstruction or, margin conforming to the meningeal plane (Fig. 3).25,28–35
possibly, overproduction of cerebrospinal fluid. Tumors Thickening of meninges adjacent to the tumor (dural tail
may be hypo-, iso- or hyperintense in T1W images and are sign) is often associated with meningiomas.33,36 In humans,
usually hyperintense in T2W images. CPT often appear the dural tail represents reactive meninges, not actual
heterogeneous, particularly when there is intratumoral tumor extension, hence this sign, though supportive of an
hemorrhage. Mild to moderate edema is present in about extraaxial lesion, is not pathognomonic for meningioma.
45% of CPP and about 70% of CPC.20 CPT usually show Signal void of the adjacent calvarium as a result of reactive
marked, uniform contrast enhancement, which reflects the hyperostosis is another sign associated with meningioma.37
S56 WISNER, DICKINSON, AND HIGGINS 2011

Fig. 2. Choroid plexus carcinoma arising from the dorsal aspect of the third ventricle. The mass is nonuniformly T1-weighted (T1W) hypointense (A), T2-
weighted (T2W) hyperintense (B), and intensely and heterogeneously contrast enhancing (C,D). Mild asymmetrical distension of the lateral ventricles suggests
partial obstruction of the interventricular foramina. Moderate distension of the mesencephalic aqueduct and fourth ventricle may reflect overproduction of
cerebrospinal fluid by the tumor. Major differentials for an intraventricular contrast enhancing mass include choroid plexus tumors, ependymoma, meningioma
and, less commonly, glioma. Parasagittal contrast-enhanced T1W image of a different dog with a choroid plexus carcinoma arising from the one of the lateral
apertures (E). A second, smaller contrast-enhancing mass ventral to the brain stem represents a regional metastatic mass.

Lymphoma and Hematopoietic Tumors Consistent with the variable manifestations of primary
or metastatic lymphoma, intracranial lymphoma may be
Lymphoma
mass-like, diffuse, or multicentric. Most primary lesions
Lymphoma is a relatively uncommon intracranial have a mild to moderate mass effect, are iso- or hypoin-
neoplasm that generally occurs in younger patients (3–7 tense on T1W images, slightly hyperintense on T2W
years) than other intracranial tumors and without any images, and have minimal to moderate peritumoral edema.
apparent breed predisposition.8 Intracranial lymphoma Primary CNS lymphoma in dogs consistently enhances
may be primary or metastatic within the CNS and either after gadolinium administration but its degree and distri-
B- or T-cell type. In humans, primary CNS lymphoma bution is variable (Fig. 4).38–43 In dogs with lymphoma
occurs mainly in immunocompromised patients, is over- metastasis to the cranial nerves, the affected nerves may be
whelmingly B-cell phenotype, and presents as a solitary markedly and uniformly enlarged and meningeal enhance-
invasive periventricular mass. There are few published ment may be diffuse. Diagnosis of intracranial lymphoma
descriptions of MR features of intracranial lymphoma is possible on the basis of cerebrospinal fluid cytology,
in dogs and no distinction between primary and which may eliminate the need for brain biopsy.
metastatic forms has been made in imaging studies. In
our experience, canine primary intracranial lymphoma
Histiocytic Tumors
frequently affects the thalamic/hypothalamic/sellar
region, while metastatic lesions are disseminated in the CNS histiocytic sarcoma is a rare neoplasm of the
meninges, choroid plexus, multiple cranial nerves, and hematopoietic system with cellular features of malig-
pituitary gland. nancy and meningeal and brain parenchyma invasion
Vol. 52, No. 1, Supplement 1 MR IMAGING OF INTRACRANIAL NEOPLASIA S57

Fig. 3. Meningioma in the region of the right temporal/parietal lobes (A–D). The mass is heterogeneously T2-weighted (T2W) hyperintense (A), mildly T1-
weighted (T1W) hypointense (B), and intensely contrast enhancing (C,D). A dural tail sign is seen rostral and caudal to the mass on the dorsal plane image (D).
Moderate peritumoral vasogenic edema is evident on the T2W image (A). Hemorrhagic meningioma involving the basilar aspect of the left brainstem (E–H).
The mass is T2W hyperintense (E), minimally T1W hypointense (G), and central signal heterogeneity and T2 susceptibility effect (F) is indicative of
hemorrhage. The mass is intensely and uniformly contrast enhancing (H).

indicating biologically aggressive behavior.44–46 On the ba- ages, although the degree of contrast enhancement may be
sis of limited experience, it appears that histiocytic sarcoma less than meningiomas with a fine granular pattern to the
tends to present as an extradural or intradural/extraaxial enhancement (Fig. 5). Dural tail signs have been reported
mass, although diffuse meningeal and intraaxial forms also inconsistently with these tumors.44
occur. These tumors are iso- to hypointense in T1W images
and iso- to hyperintense in T2W images, and cause a Sellar Region Tumors
marked mass effect accompanied by regional or diffuse
Pituitary Adenoma and Adenocarcinoma
peritumoral edema. As observed with meningiomas, the
internal margins of extraaxial histiocytic sarcomas may Pituitary tumors usually arise from the adenohypophysis;
appear well defined on T2W and postcontrast T1W im- tumors of the neurohypophysis are very rare.47–51 Adeno-

Fig. 4. Intracranial lymphoma involving the thalamic/hypothalamic region. Ill-defined T2-weighted (T2W) hyperintensity (A), T1-weighted (T1W) iso-
intensity (B), and mild poorly demarcated contrast enhancement (C) is evident and mass effect is minimal. The contrast distribution volume is smaller than the
T2 hyperintensity volume suggesting mild lesional and perilesional edema.
S58 WISNER, DICKINSON, AND HIGGINS 2011

Fig. 5. Extraaxial histiocytic sarcoma in the region of the left frontal lobe. There is a moderate mass effect associated with mild T1-weighted (T1W)
hypointensity (A), T2-weighted (T2W) isointensity (B), and moderate to marked peritumoral edema. The mass is moderately contrast enhancing and with
additional pronounced peritumoral meningeal enhancement (C,D). A primary differential for a contrast enhancing peripheral mass would be meningioma.

hypophyseal tumors are not included in the human WHO cally isointense in T1W images, mildly hyperintense in T2W
2007 classification scheme of CNS tumors but are included images, and show marked uniform contrast enhancement.
here because they arise in close proximity to the brain and Both adenomas and adenocarcinomas may be cystic and/or
must be distinguished from other intracranial tumors. hemorrhagic. They are frequently accompanied by sur-
The pituitary gland does not normally extend dorsal to rounding regional edema, particularly when large enough
the dorsum sellae in sagittal MR images and should not to cause a significant mass effect. Macroadenomas some-
have an overtly convex dorsal margin. Average height of times invade adjacent bone. In one study invasive adeno-
the normal canine pituitary gland is approximately 5 mm mas were larger than noninvasive adenomas (1.9 vs. 1.2 cm
with little correlation to body weight or brain volume.52 mean height),50 but MR imaging features of adenomas, in-
Pituitary microadenomas are generally defined as being vasive adenomas, and adenocarcinomas are not sufficiently
o10 mm in height, but often result in increased convexity different to reliably distinguish these entities.
of the dorsal pituitary margin and may cause dorsal and
lateral displacement of the neurohypophysis (Fig. 6). The Other Sellar Region Tumors
neurohypophysis often appears hyperintense in T1W im-
Other neoplasms that can arise from within the sellar
ages, which (in humans) reflects the presence of neurose-
and suprasellar region and must be distinguished from pi-
cretory granules thought to represent vasopressin.53
tuitary tumors include meningioma, lymphoma, ependy-
Dynamic contrast-enhanced computed tomography and
moma, granular cell, and germ cell tumors. Tumors that
MR imaging can be used to more clearly identify pituitary
arise from the neurohypophysis and other sellar tumors
microtumors based on temporal differences in enhancement
such as craniopharyngiomas are extremely rare.
of the neurohypophysis and adenohypophyseal mass.54,55
Presumptive diagnosis of pituitary macrotumor is usually
straightforward, based on finding a midline mass of Metastatic Tumors
410 mm arising from the sellar region (Fig. 7).15,48–52,56 In a series of 177 secondary intracranial neoplasms in
Pituitary macroadenomas and adenocarcinomas are typi- dogs, 29% were hemangiosarcomas and 12% were meta-
Vol. 52, No. 1, Supplement 1 MR IMAGING OF INTRACRANIAL NEOPLASIA S59

Fig. 6. Appearance of a normal pituitary gland on an unenhanced sagittal plane T1-weighted (T1W) image (A). The focus of hyperintensity represents
neurosecretory granules in the neurohypophysis. The dorsal margin of the pituitary does not extend beyond the rim of the dorsum sellae and has only a mildly
convex shape. Pituitary microadenoma on sagittal plane (B) and transverse plane (C) contrast enhanced T1W images. The pituitary gland is enlarged and
extends beyond the dorsum sellae. The hyperintense neurohypophysis is displaced caudally, dorsally, and to the right of midline by the adenohypophyseal mass.

static carcinomas.40 Lymphoma and pituitary tumors were 20% of secondary (metastatic) intracranial neoplasms, re-
included in this study, but if these neoplasms are excluded, spectively.40 Metastatic tumors appear to preferentially
hemangiosarcoma and carcinomas account for 50% and distribute to the gray–white matter interface, which may

Fig. 7. Pituitary macroadenoma. An ill-defined T2-weighted (T2W) mixed intensity (A), T1-weighted (T1W) hypointense (A–C) mass involves the thalamus
and hypothalamus and extends ventrally to involve the pituitary fossa. A focal susceptibility effect on a T2 image is indicative of intratumoral hemorrhage (D).
The mass is uniformly and intensely contrast enhancing and dural tail signs are present suggesting an extraaxial location (E,F). Although pituitary macrotumor
is the most likely diagnosis and was confirmed in this patient, other extraaxial tumors such as meningioma, granular cell tumor, germ cell tumor, and histiocytic
sarcoma should also be included in a differential diagnosis. Imaging characteristics of pituitary macroadenomas and pituitary carcinomas are not sufficiently
different to distinguish between the two.
S60 WISNER, DICKINSON, AND HIGGINS 2011

Fig. 8. Metastatic hemangiosarcoma. A large mass of mixed signal intensity on T2-weighted (T2W) (A) and T1-weighted (T1W) (B) images is present within
the left thalamus. A second smaller mass is seen in the left parietal lobe adjacent to the falx cerebri. Both masses have a complex susceptibility effect on the T2
sequence (C) indicative of extensive intratumoral hemorrhage. Marked peripheral contrast enhancement of both masses is seen (D).

reflect the likelihood of tumor emboli lodging in the cor- Contrast enhancement is variable and often peripheral
tical arterioles where they narrow at this interface.10,11 (Fig. 8). In our experience, metastatic carcinoma also ap-
In MR images of the brain, metastatic hemangiosarcoma pears as multiple contrast-enhancing ill-defined mass lesions
often appears as multiple mass lesions, although metastasis with variable peritumoral edema, but without the intratu-
should still be considered when a solitary lesion is found. moral hemorrhage characteristic of hemangiosarcoma.
Hemangiosarcomas typically have a marked mass effect,
mixed signal intensity in T1W and T2W images and signal
void (susceptibility effect) in T2W sequences due to int- ACKNOWLEDGMENT
ratumoral hemorrhage. Peritumoral edema may be marked. Disclosure: The authors declare no conflict of interest.

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