F-18 Fluorodeoxyglucose PET/CT and Post Hoc PET/MRI in a Case of Primary Meningeal Melanomatosis

Lee, Hong Je; Ahn, Byeong‐Cheol; Hwang, Seong Wook; Cho, Suk Kyong; Kim, Hae Won; Lee, Sang‐Woo; Hwang, Jeong-In; Lee, Jaetae

doi:10.3348/kjr.2013.14.2.343

Cited by 19 publications

(11 citation statements)

References 14 publications

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“…We identified 26 cases [ 9 , 10 , 11 , 12 , 13 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 ] by screening EMBASE and PubMed for leptomeningeal melanomatosis, which provided sufficient information to be reliably classified as PDLMM. The main reason for exclusion were nodular lesions suggestive of primary CNS melanoma, or low mitotic frequency and lack of atypia and invasion signs indicative of primary leptomeningeal melanocytosis ( Supplementary Materials Figure S1 ).…”

Section: Resultsmentioning

confidence: 99%

Novel Insights into Diagnosis, Biology and Treatment of Primary Diffuse Leptomeningeal Melanomatosis

Baumgartner

Stepien

Mayr

et al. 2021

JPM

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Primary diffuse leptomeningeal melanomatosis (PDLMM) is an extremely rare and aggressive cancer type for which best treatment strategies remain to be elucidated. Herein, we present current and prospective diagnostic strategies and treatment management of PDLMM. Against the background of an extensive literature review of published PDLMM cases and currently employed therapeutic strategies, we present an illustrative case of a pediatric patient suffering from PDLMM. We report the first case of a pediatric patient with PDLMM who received combination treatment including trametinib and everolimus, followed by intravenous nivolumab and ipilimumab with concomitant intensive intraventricular chemotherapy, resulting in temporary significant clinical improvement and overall survival of 7 months. Following this clinical experience, we performed a comprehensive literature review, identifying 26 additional cases. By these means, we provide insight into current knowledge on clinical and molecular characteristics of PDLMM. Analysis of these cases revealed that the unspecific clinical presentation, such as unrecognized increased intracranial pressure (present in 67%), is a frequent reason for the delay in diagnosis. Mortality remains substantial despite diverse therapeutic approaches with a median overall survival of 4 months from diagnosis. On the molecular level, to date, the only oncogenic driver reported so far is mutation of NRAS (n = 3), underlining a close biological relation to malignant melanoma and neurocutaneous melanosis. We further show, for the first time, that this somatic mutation can be exploited for cerebrospinal fluid liquid biopsy detection, revealing a novel potential biomarker for diagnosis and monitoring of PDLMM. Last, we use a unique patient derived PDLMM cell model to provide first insights into in vitro drug sensitivities. In summary, we provide future diagnostic and therapeutic guidance for PDLMM and first insights into the use of liquid biopsy and in vitro models for this orphan cancer type.

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Section: Resultsmentioning

confidence: 99%

Novel Insights into Diagnosis, Biology and Treatment of Primary Diffuse Leptomeningeal Melanomatosis

Baumgartner

Stepien

Mayr

et al. 2021

JPM

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“…Post-hoc PET/MR fusion images facilitated the correlation between the PET and MR images, and revealed the hypermetabolic lesions more accurately than the unenhanced PET/CT images did. Whole-body F-18 FDG PET/CT and post-hoc PET/MR images may aid clinicians in determining the best therapeutic strategy for patients with primary meningeal melanomatosis ( 21 ).…”

Section: Discussionmentioning

confidence: 99%

Intracranial malignant melanoma: A report of 7 cases

Gui

Lang

2015

Oncology Letters

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The aim of the present study was to investigate the clinical diagnosis and treatment of intracranial malignant melanoma. For this purpose, the clinical manifestation, signs, cerebrospinal fluid (CSF) contents, imageology, pathological features, treatment and prognosis of 7 cases of intracranial malignant melanoma were analyzed in The Chinese PLA General Hospital (Beijing, China) from 1996 to 2013. All the melanoma cases were confirmed by histopathology, and CSF cytopathology demonstrated that there were 5 cases of primary malignant melanoma and 2 cases of secondary malignant melanoma. Among the patients, 4 presented with >1 pigmented nevus in the skin, and 1 presented with skin melanoma. Intracranial malignant melanoma mostly affects middle-aged males. CSF cytopathology and imageology (particularly enhanced magnetic resonance), are important tools in the diagnosis of the disease. Particularly, when a patient presents with a pigmented nevus in the skin and an abnormal lesion in the brain, a diagnosis of intracranial malignant melanoma should be considered.

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“…Several publications also investigated the superiority of PET/MRI versus PET/CT in the detection and conspicuity of intracranial lesions. 15 , 16 It is worth mentioning that PET images of all presented showed hypometabolism in the homolateral basal nuclei and thalamus, whereas the FSE T2 image and FLAIR MRI done at the same time demonstrated no significant change. In addition, case 3 indicates that the frontal cortical edema can also lead to CCD although the metastasis itself is small and located in the subcortical region.…”

Section: Discussionmentioning

confidence: 79%

Crossed Cerebellar Diaschisis

Han

Wang

et al. 2016

Medicine

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Crossed cerebellar diaschisis (CCD) describes a depression of oxidative metabolism glucose and blood flow in the cerebellum secondary to a supratentorial lesion in the contralateral cerebral hemisphere. PET/MR has the potential to become a powerful tool for demonstrating and imaging intracranial lesions .We herein report 3 cases of CCD imaging using a tri-modality PET/CT–MR set-up for investigating the value of adding MRI rather than CT to PET in clinical routine.We describe 3 patients with CCD and neurological symptoms in conjunction with abnormal cerebral fluorodeoxyglucose (FDG) positron emission tomography/computed tomography-magnetic resonance imaging (PET/CT–MR) manifestations including arterial spin-labeling (ASL) and T2-weighted images. In all, 18FDG-PET/CT detected positive FDG uptake in supratentorial lesions, and hypometabolism with atrophy in the contralateral cerebellum. More than that, hybrid PET/MRI provided a more accurate anatomic localization and ASL indicated disruption of the cortico-ponto-cerebellar pathway.Using pathology or long-term clinical follow-up to confirm the PET and ASL findings, the supratentorial lesions of the 3 patients were respectively diagnosed with cerebral infarction, recurrent glioma, and metastasis.The reports emphasize the signiﬁcance of multimodality radiological examinations. Multimodality imaging contributes to proper diagnosis, management, and follow-up of supratentorial lesions with CCD.

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F-18 Fluorodeoxyglucose PET/CT and Post Hoc PET/MRI in a Case of Primary Meningeal Melanomatosis

Cited by 19 publications

References 14 publications

Novel Insights into Diagnosis, Biology and Treatment of Primary Diffuse Leptomeningeal Melanomatosis

Novel Insights into Diagnosis, Biology and Treatment of Primary Diffuse Leptomeningeal Melanomatosis

Intracranial malignant melanoma: A report of 7 cases

Crossed Cerebellar Diaschisis

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