Perfusion MR Imaging of an Intracranial Collision Tumor Confirmed by Image-Guided Biopsy

Images of a 56-year-old woman with a history of breast carcinoma presenting with 2 weeks of headache, nausea, and vomiting. Image-guided open biopsy demonstrated a collision tumor between a typical meningioma and metastatic breast carcinoma.

A, Axial fluid-attenuated inversion recovery (10,000/148/2,200 milliseconds [TR/TE/TI]) image. A heterogeneously intense, right anterior frontal bilobed mass (straight arrows) is seen with surrounding edema and hemorrhage (curved arrows).

B, Axial postcontrast spoiled gradient-recalled (SPGR; 34/8) T1-weighted image. The mass demonstrates uniform contrast enhancement with a posterior rim of hemorrhage (curved arrows).

C, Perfusion MR color map overlaid onto the corresponding axial postcontrast section. Relative cerebral blood volume is increased within the bilobed enhancing lesion. Two regions of interest, labeled 1 and 2, are defined on the anterior and posterior lobes of the tumor.

D, T2* susceptibility signal intensity-time curves. The anterior (1) and posterior (2) lobes demonstrate differences in the degree of signal intensity drop and pattern of signal intensity recovery.