Symmetric Ventral Brainstem Lesion in Leptomeningeal Carcinomatosis

Maeda, Kengo; Wada, Hiroshi; Ozaki, Yoshitomo; Inoue, Akitoshi

doi:10.2169/internalmedicine.1469-18

Cited by 4 publications

(11 citation statements)

References 2 publications

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“…The researchers referred to the areas of hyperintensity as having the "bloomy rind sign." Other reports also observed the same hyperintensity in lung adenocarcinoma patients with the EGFR mutation [3] , [4] , [5] , [6] . Therefore, our present case is consistent with previous reports.…”

Section: Discussionsupporting

confidence: 63%

“…Since leptomeningeal carcinomatosis is rarely observed at the initial presentation, diagnosis is often delayed. Although leptomeningeal carcinomatosis is usually diagnosed by observing an abnormal contrast enhancement along the brain surface [1] , there have been several reports of band-like abnormalities along the surface of the brain stem without contrast enhancement especially in patients with lung adenocarcinoma [2] , [3] , [4] , [5] , [6] . Herein, we report a case of lung adenocarcinoma with leptomeningeal carcinomatosis at initial presentation and characteristic abnormal hyperintensity along the ventral surface of the brain stem on fluid-attenuated inversion recovery (FLAIR) and diffusion-weighted imaging (DWI).…”

Section: Introductionmentioning

confidence: 99%

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

Yokota

Mukai

Hattori

et al. 2022

Radiology Case Reports

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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.

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Section: Discussionsupporting

confidence: 63%

Section: Introductionmentioning

confidence: 99%

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

Yokota

Mukai

Hattori

et al. 2022

Radiology Case Reports

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“…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: 99%

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

et al. 2020

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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.

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“…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].…”

Section: Introductionmentioning

confidence: 99%

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

Obara¹

2022

Cureus

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Leptomeningeal metastasis (LM) is a severe complication of primary malignancy that has spread to the leptomeninges and cerebrospinal fluid (CSF). Here, we report a patient whose magnetic resonance imaging (MRI) showed a unique brainstem lesion suspicious of LM. A 72-year-old man presented with dizziness, gait instability, and cognitive decline, primarily object naming. He had a history of lung adenocarcinoma with epidermal growth factor receptor (EGFR) mutation. Brain MRI revealed a band-like lesion surrounding the ventral brainstem with T2 weighted-image/fluid attenuation inversion recovery (FLAIR) imaging and diffusion-weighted imaging (DWI) hyperintensity without gadolinium enhancement. No malignant cells were detected in the CSF. He underwent ventriculoperitoneal shunt two months after the onset, and his gait improved, but his cognitive function declined further. Recent reports suggest similar brainstem lesions as a unique LM pattern, which occurs almost exclusively in patients with lung adenocarcinoma with EGFR mutation. Therefore, if MRI shows this brainstem finding, repeated and appropriate CSF cytology is needed to detect tumor cells. Furthermore, if a patient with lung adenocarcinoma shows a cognitive decline, cerebral LM and auto-antibodies that mainly target neuronal surface antigens should be considered.

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Symmetric Ventral Brainstem Lesion in Leptomeningeal Carcinomatosis

Cited by 4 publications

References 2 publications

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

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

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

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

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