CT of intracranial metastases with skull and scalp involvement.

Twenty-eight persons with contiguous intracranial skull, and often extracranial metastatic disease are reported. These lesions comprised 7.6% of a series of 250 consecutive patients with intracranial metastatic disease. Only three of 28 patients had other intracranial lesions and only seven of 28 patients has other skull lesions demonstrable on computed tomography (CT). Carcinoma of the prostate and breast, multiple myeloma, and neuroblastoma are especially likely to appear in this manner. All metastases enhanced. The bone destruction was so pervasive that in 19 of the patients it was obvious at routine CT settings. In the nine other patients, it could be clearly seen only at bone settings (high window and level). The CT demonstration of an enhancing intracranial mass involving the skull and often the scalp is highly suggestive but not diagnostic of a metastatic lesion.