Band-like hyperintensity along the ventral surface of the brain stem on FLAIR and DWI in leptomeningeal carcinomatosis of lung adenocarcinoma

Abstract

Since leptomeningeal carcinomatosis is rarely observed before diagnosis of the primary cancer, its detection is often delayed. We report the case of a 60-year-old woman who presented with lung adenocarcinoma with leptomeningeal carcinomatosis. Magnetic resonance imaging showed the characteristic abnormal hyperintensity along the ventral surface of the brain stem on fluid-attenuated inversion recovery and diffusion weighted imaging. It had no contrast uptake. Based on these findings, we were able to make an early diagnosis of leptomeningeal carcinomatosis of lung adenocarcinoma. This condition was resolved after treatment with a tyrosine kinase inhibitor.

Band-Like Brainstem Lesion in a Patient With a History of Lung Adenocarcinoma

“…We reviewed the English literature in PubMed and identified 22 cases with brainstem MRI findings that were similar to that of our patient (Table 1) [5,6,[8][9][10][11][12]. All cases had a lung adenocarcinoma or a history of lung adenocarcinoma [5,6,[8][9][10][11][12]. Seventeen cases had EGFR mutations [6,[8][9][10][11][12].…”

“…All cases had a lung adenocarcinoma or a history of lung adenocarcinoma [5,6,[8][9][10][11][12]. Seventeen cases had EGFR mutations [6,[8][9][10][11][12]. Eighteen cases concurrently suffered from the brain, bone, and lung-to-lung metastasis and had undergone systemic chemotherapy or radiotherapy [5,6,[8][9][10]12].…”

“…Seventeen cases had EGFR mutations [6,[8][9][10][11][12]. Eighteen cases concurrently suffered from the brain, bone, and lung-to-lung metastasis and had undergone systemic chemotherapy or radiotherapy [5,6,[8][9][10]12]. Malignant cells in CSF were identified in 15 cases and were diagnosed as LM due to lung adenocarcinoma [6,[8][9][10][11][12].…”

“…Typically, LM is revealed as focal or diffuse, nodular or linear enhancement of the leptomeninges along the brain sulci and cistern on contrast-enhanced T1WI [4][5][6][7]. However, some recent case reports describe a band-like lesion surrounding the ventral brainstem with restricted diffusion and without gadolinium enhancement on MRI as a unique LM pattern [5,6,[8][9][10][11][12]. Moreover, this LM pattern occurs almost exclusively in patients with lung adenocarcinoma with epidermal growth factor receptor (EGFR) mutation [6,[8][9][10][11][12].…”

“…However, some recent case reports describe a band-like lesion surrounding the ventral brainstem with restricted diffusion and without gadolinium enhancement on MRI as a unique LM pattern [5,6,[8][9][10][11][12]. Moreover, this LM pattern occurs almost exclusively in patients with lung adenocarcinoma with epidermal growth factor receptor (EGFR) mutation [6,[8][9][10][11][12]. Herein, we report a patient with a history of lung adenocarcinoma with EGFR mutation who presented with a band-like ventral brainstem lesion on MRI and simultaneously showed a rapid cognitive decline.…”