Exceptional symmetric anterior brainstem involvement in leptomeningeal carcinomatosis

Crombé, Amandine; Alberti, N; Durieux, M.; Frulio, Nora; Dousset, V.; Tourdias, Thomas

doi:10.1016/j.neurad.2014.05.003

Cited by 14 publications

(22 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We reviewed the literature and identified three more cases with similar brain MRI findings ( 3 , 4 ). The clinical characteristics of the seven cases are summarized in Table 1 .…”

Section: Literature Reviewmentioning

confidence: 99%

Novel Anterior Brainstem Magnetic Resonance Imaging Findings in Non-Small Cell Lung Cancer with Leptomeningeal Carcinomatosis

Cheng¹,

Hsu²,

Tsai³

et al. 2017

Front. Neurol.

View full text Add to dashboard Cite

Leptomeningeal carcinomatosis (LC) is found in around 4% of patients with non-small cell lung cancer (NSCLC). The most common radiological finding of LC is diffuse leptomeningeal enhancement on contrast-enhanced brain magnetic resonance imaging (MRI). Herein, we report a novel brain MRI finding—non-enhanced, band-like, symmetric restricted diffusion along the anterior surface of the brainstem—of LC in four patients with NSCLC. We also identified three additional cases with similar MRI findings in a literature review. We hypothesized that the restricted diffusion along the anterior brainstem was caused by malignant cells concentrating in the cistern around the brainstem and infiltrating into the circumferential perforating arteries along the anterior brainstem surface, which then resulted in microinfarctions.

show abstract

“…We reviewed the literature and identified three more cases with similar brain MRI findings ( 3 , 4 ). The clinical characteristics of the seven cases are summarized in Table 1 .…”

Section: Literature Reviewmentioning

confidence: 99%

Novel Anterior Brainstem Magnetic Resonance Imaging Findings in Non-Small Cell Lung Cancer with Leptomeningeal Carcinomatosis

Cheng¹,

Hsu²,

Tsai³

et al. 2017

Front. Neurol.

View full text Add to dashboard Cite

show abstract

“…Reviewing the literature, we identified nine cases with similar MR findings, all of which had lung adenocarcinoma [ 6 , 7 , 9 , 10 ]. The clinical characteristics of the nine cases are summarized in Table 2 .…”

Section: Discussionmentioning

confidence: 99%

“…A few case reports demonstrated abnormalities in fluid-attenuated inversion recovery (FLAIR) imaging of non-enhancing intracranial metastases including LM [ 3 – 10 ]. In particular, FLAIR hyperintensity in the brainstem surface, looking like a bloomy rind on cheese, was a peculiar finding shown to contribute to the detection of subtle LM in four previous studies [ 6 , 7 , 9 , 10 ]. This abnormal finding may reflect both an early stage of cancer spread in the CSF space and also the progression of invasion in the brain surface.…”

Section: Introductionmentioning

confidence: 90%

FLAIR hyperintensity along the brainstem surface in leptomeningeal metastases: a case series and literature review

et al. 2020

View full text Add to dashboard Cite

Background The incidence of leptomeningeal metastasis (LM) is underestimated because of its non-specific signs and the low sensitivity of clinical diagnostic modalities. Cerebrospinal magnetic resonance (MR) imaging with and without contrast enhancement (CE) is a gold standard for the neuroradiological assessment of patients with suspected LM. Previous studies suggested that some LM cases show changes of the brainstem surface on non-contrast MR images without or before the appearance of abnormalities on CE images. We assessed the features of this non-contrast MR finding in a cohort of LM patients in this retrospective single-institution study. Methods We reviewed head MR images and clinical data of 142 consecutive patients in whom the final diagnosis was LM. Results We found that 11 of these 142 patients (7.7%) with LM had band-like hyperintensity on the brainstem surface on non-enhanced FLAIR images, which looked like bloomy rind on cheese. Three of seven patients who were examined using diffusion-weighted imaging showed restricted diffusion in the corresponding lesion site. The above-mentioned 11 patients included 10 women and 1 man, with a median age of 61 years. All 11 patients had primary lung adenocarcinoma. Seven patients had symptomatic hydrocephalus. Ten patients had EGFR-mutated and one had ALK-rearrangement adenocarcinomas. Before the diagnosis of LM, 10 patients had undergone systemic therapy with EGFR-TKI or pemetrexed, and 1 patient with ALK inhibitor and bevacizumab. Conclusions We present a series of patients with bloomy rind sign that is non-enhancing LM reliably detected by FLAIR hyperintensity on the brainstem surface. This finding is rare, but may reflect the spread of cancer cells in both the leptomeningeal membrane and the surface of the brain parenchyma specifically in patients with lung adenocarcinomas. Further study is needed to determine the clinical significance of this sign, and the pathophysiological factors associated with it may be clarified by analyzing serial MR images in a larger cohort of patients treated for LM.

show abstract

“…To our knowledge, only one case with similar MRI findings has been recently reported. 5 The pathogenesis of the cytotoxic edema along the brain stem surface is unknown. We think there are 3 possible explanations for our finding: microinfarctions secondary to tumor cell infiltration in the perforating vessels, paraneoplastic encephalopathy involving the brain stem, and toxic encephalopathy caused by chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

“… 6 The malignant cells in the CSF cistern around the brain stem could directly infiltrate the microvessels or extend into the subpial space, causing perivascular inflammatory reaction and thrombosis. 7 , 8 Crombe et al 5 reported of a patient diagnosed with lung adenocarcinoma who showed diffuse high signal intensity on T2-weighted images and DWI, only along the anterior surface of the brain stem and on both sides of the middle cerebellar peduncles. However, our patient showed high signal intensity along the entire surface of the brain stem.…”

Section: Discussionmentioning

confidence: 99%

Symmetrical Curvilinear Cytotoxic Edema Along the Surface of the Brain Stem

et al. 2015

View full text Add to dashboard Cite

Lung cancer is one of the most common neoplasms to appear leptomeningeal metastasis (LM). Contrast-enhanced magnetic resonance imaging (MRI) is better diagnostic choice for LM and usually shows focal nodular or diffuse linear enhancement on the leptomeninges along the sulci and tentorium in the brain. We experienced atypical 2 cases of lung cancer in patients who showed unusual brain MRI finding of symmetrical curvilinear or band-like, nonenhancing cytotoxic edema along the surface of the brain stem. This finding is unique and different from the general findings of leptomeningeal metastasis.This unique imaging finding of symmetric curvilinear nonenhancing cytotoxic edema along the brainstem is extremely rare and represents a new presentation of leptomeningeal carcinomatosis.

show abstract

Exceptional symmetric anterior brainstem involvement in leptomeningeal carcinomatosis

Cited by 14 publications

References 5 publications

Novel Anterior Brainstem Magnetic Resonance Imaging Findings in Non-Small Cell Lung Cancer with Leptomeningeal Carcinomatosis

Novel Anterior Brainstem Magnetic Resonance Imaging Findings in Non-Small Cell Lung Cancer with Leptomeningeal Carcinomatosis

FLAIR hyperintensity along the brainstem surface in leptomeningeal metastases: a case series and literature review

Symmetrical Curvilinear Cytotoxic Edema Along the Surface of the Brain Stem

Contact Info

Product

Resources

About