November 30, 2010

Leptomeningeal Enhancement

Sagittal T1W MR image post gadolinium shows extensive leptomeningeal enhancement (arrrows) along the cerebral sulci and cerebellar folia.

Differential Diagnosis:
  • Leptomeningeal carcinomatosis: usually due to breast or lung metastasis, or primary CNS tumor. In children, the most common cause is medulloblastoma.
  • Meningitis (bacterial, tuberculosis, coccidiodomycosis)
  • Neurosarcoidosis: often involves the basal cistern
Facts: Leptomeningeal Carcinomatosis
  • Hematogenous spread of malignancy (i.e., breast, lung) or direct extension by CNS tumor
  • MRI with contrast administration best imaging tool to detect this abnormality, much more sensitive than CT
  • Imaging Findings: smooth or nodular enhancement along the leptomeninges (extending into sulci), hyperintensity of sulci on FLAIR, hydrocephalus (which may be the only sign seen on CT)
Our case: Leptomeningeal carcinomatosis from esophageal cancer

1. O'Brien WT. Top 3 differentials in radiology: a case review, 2009.
2. Lev MH, Heisserman J, Shetty S. Q&A color review of neuroimaging, 2008.

No comments:

Post a Comment