Leiomyosarcoma leptomeningeal brain metastases

Area of Science:

• Neurology
• Oncology
• Radiology

Background:

• Brain metastases from soft tissue sarcomas (STS) are uncommon, usually appearing late in disease progression, often after lung metastases.
• Intracranial STS metastases are predominantly intraparenchymal.
• Leptomeningeal and perivascular space involvement can be subtle and difficult to detect.

Purpose of the Study:

• To describe two cases of intracranial metastatic soft tissue leiomyosarcomas.
• To highlight the diagnostic challenges of small leptomeningeal and perivascular metastases.
• To recommend optimal MRI techniques for detecting these lesions.

Main Methods:

• Case report of two patients with histologically confirmed intracranial metastatic soft tissue leiomyosarcomas.
• Detailed analysis of MRI findings, focusing on lesion detection and characterization.
• Evaluation of MRI parameters, including slice thickness and contrast enhancement.

Main Results:

• Nodular metastases ≤10 mm in the leptomeningeal spaces were detectable by MRI.
• Larger lesions became difficult to distinguish from intra-axial masses.
• Small lesions in leptomeningeal and perivascular spaces posed detection challenges.

Conclusions:

• Global gadolinium-enhanced MRI with contiguous 1 mm slice thickness is recommended for detecting small intracranial STS metastases.
• Accurate detection of lesion multiplicity and location is vital for patient management.
• Advanced MRI protocols improve the identification of rare, challenging brain metastases.