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MRI manifestations of leptomeningeal metastasis
1Department of Radiology, Kaohsiung Medical College, Taiwan, Republic of China.
Abstract:
Twenty-six cases with leptomeningeal metastasis were analyzed and Gd-DTPA enhanced MR imaging was found to be the most useful tool for making the diagnosis. The important manifestations in order of frequency were: 1) leptomeningeal enhancement; 2) ependymal enhancement; 3) plaque, nodule or mass in the subarachnoid space or ventricles; 4) nerve root thickening; and 5) ventricular dilatation not related to the obstruction of the primary neoplasm. A review of the literature has shown that intracranial leptomeningeal metastasis from spinal cord astrocytoma are very rare. In our series, 3 cases with primary brain tumors developed spinal subarachnoid involvement. This paper also reviews 1 case with thoracic cord astrocytoma which developed multiple intracranial leptomeningeal metastasis.
Insights
Gadolinium-DTPA enhanced magnetic resonance (MR) imaging is crucial for diagnosing leptomeningeal metastasis. This study highlights key imaging findings and the rarity of intracranial metastasis from spinal cord astrocytoma.
Area of Science:
- Neurology
- Radiology
- Oncology
Background:
- Leptomeningeal metastasis (LM) is a serious complication of cancer.
- Accurate diagnosis is essential for appropriate treatment and prognosis.
- Intracranial spread from spinal astrocytomas is particularly uncommon.
Purpose of the Study:
- To evaluate the diagnostic utility of Gd-DTPA enhanced MR imaging in leptomeningeal metastasis.
- To identify and rank the frequency of characteristic imaging findings in LM.
- To investigate the occurrence of intracranial metastasis from spinal cord astrocytoma.
Main Methods:
- Retrospective analysis of 26 cases diagnosed with leptomeningeal metastasis.
- Detailed review of Gd-DTPA enhanced MR imaging findings.
- Literature review focusing on intracranial metastasis from spinal cord astrocytoma.
Main Results:
- Gd-DTPA enhanced MR imaging was the most effective diagnostic tool.
- The most frequent findings included leptomeningeal enhancement, ependymal enhancement, and subarachnoid/ventricular lesions.
- Nerve root thickening and non-obstructive ventricular dilatation were also noted.
- Three cases with primary brain tumors showed spinal subarachnoid involvement.
- One case of thoracic cord astrocytoma presented with multiple intracranial leptomeningeal metastases.
Conclusions:
- Gd-DTPA enhanced MR imaging is highly valuable for diagnosing leptomeningeal metastasis.
- Leptomeningeal enhancement is the most common imaging manifestation.
- Intracranial leptomeningeal metastasis from spinal cord astrocytoma is rare but can occur.