{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:05:48Z","timestamp":1756339548031,"version":"3.44.0"},"reference-count":6,"publisher":"BMJ","issue":"10","license":[{"start":{"date-parts":[[2022,10,26]],"date-time":"2022-10-26T00:00:00Z","timestamp":1666742400000},"content-version":"unspecified","delay-in-days":25,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2022,8,9]]},"published-print":{"date-parts":[[2022,10]]},"abstract":"<jats:p>A man in his 70s presented to the emergency department with a 3-day history of confusion and right-facial droop. He was diagnosed with stage IIIB (T4N2M0) malignant mesothelioma 6 months previously for which he was being given palliative chemotherapy. An MRI of the brain demonstrated a left parietal cerebral metastasis with unique radiological characteristics termed \u2018donut sign\u2019. He underwent a craniotomy and complete macroscopic resection of the lesion with a good postoperative outcome. Mesothelioma cerebral metastases are a rarely reported clinical entity, with only a handful of case reports and case series available. On MRI they often demonstrate a distinctive thick-walled lesion, termed \u2018donut sign\u2019, that may be indicative of the diagnosis. Furthermore, case autopsy series suggest these metastases may be underdiagnosed in the clinical setting due to the dismal prognosis. With newer and more effective neoplastic treatment strategies emerging, there may be a rising incidence of central nervous system metastases in the future.<\/jats:p>","DOI":"10.1136\/bcr-2021-247566","type":"journal-article","created":{"date-parts":[[2022,10,26]],"date-time":"2022-10-26T10:10:37Z","timestamp":1666779037000},"page":"e247566","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Donut sign: a unique radiological sign of cerebral metastasis in malignant mesothelioma"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3129-1114","authenticated-orcid":false,"given":"OreOluwa","family":"Adeyinka","sequence":"first","affiliation":[{"name":"Nepean Hospital, Penrith, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashraf","family":"Dower","sequence":"additional","affiliation":[{"name":"Neurosurgery, Nepean Hospital, Penrith, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yingda","family":"Li","sequence":"additional","affiliation":[{"name":"Neurosurgery, Westmead Hospital, Westmead, New South Wales, Australia"},{"name":"Westmead Clinical School, The University of Sydney Sydney Medical School, Sydney, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2022,10,26]]},"reference":[{"key":"2025082710215225000_15.10.e247566.1","doi-asserted-by":"crossref","first-page":"1075","DOI":"10.1513\/AnnalsATS.201404-165BC","article-title":"Malignant mesothelioma and central nervous system metastases. Report of two cases, pooled analysis, and systematic review","volume":"11","author":"Miller","year":"2014","journal-title":"Ann Am Thorac Soc"},{"key":"2025082710215225000_15.10.e247566.2","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1055\/s-0039-1693406","article-title":"Malignant mesothelioma: has anything changed?","volume":"40","author":"Kim","year":"2019","journal-title":"Semin Respir Crit Care Med"},{"key":"2025082710215225000_15.10.e247566.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2004.05.005"},{"key":"2025082710215225000_15.10.e247566.4","doi-asserted-by":"crossref","first-page":"779","DOI":"10.2169\/internalmedicine.55.3765","article-title":"Brain metastasis of pleural mesothelioma after a subarachnoid hemorrhage","volume":"55","author":"Hirooka","year":"2016","journal-title":"Intern Med"},{"key":"2025082710215225000_15.10.e247566.5","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1016\/S0090-3019(03)00448-8","article-title":"Solitary cerebellar metastasis of malignant pleural mesothelioma: case report","volume":"61","author":"Winfree","year":"2004","journal-title":"Surg Neurol"},{"key":"2025082710215225000_15.10.e247566.6","doi-asserted-by":"publisher","DOI":"10.4103\/2152-7806.111298"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2021-247566","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T17:21:57Z","timestamp":1756315317000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2021-247566"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10]]},"references-count":6,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2022,10,26]]},"published-print":{"date-parts":[[2022,10]]}},"alternative-id":["10.1136\/bcr-2021-247566"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2021-247566","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2022,10]]}}}