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Investigations

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  • structural MRI (defined as T2 weighted, FLAIR, DWI series and T1 pre- and post-contrast volume) is the initial diagnostic test of choice for suspected brain metastases, unless MRI is contraindicated

  • to help establish current disease status, offer extracranial imaging (appropriate to the primary tumour type) to people with any radiologically suspected brain metastases that may be suitable for focal treatment

  • all intracranial and extracranial diagnostic imaging and, if appropriate, biopsy of extracranial disease, should be performed before referral to the neuro-oncology multidisciplinary team
    • chest x-ray and a thorough clinical examination must be performed to identify the primary lesion. Biopsy or decompression to provide a tissue diagnosis may be used when the primary is unidentifiable

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