18F-FDG PET/CT Appearance of Metastatic Brachial Plexopathy Involving Epidural Space From Breast Carcinoma

Ho, Linh; Henderson, Robert W.; Luong, Thang M.; Malkhassian, Silva; Wassef, Heidi

doi:10.1097/rlu.0b013e31825ae4af

Cited by 9 publications

(5 citation statements)

References 6 publications

(6 reference statements)

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“…In the current study, however, these conditions were not taken into account for contouring and dosimetry purposes and could be interesting to further prospective investigations. Additionally, direct neoplastic spread through the peripheral nerves (for example, breast cancer spread to the brachial plexus 15,37 ) has been described and was not routinely addressed herein with PET and/or CT. Prospective study would benefit from uniform clinical, electrophysiological, pain, and quality of life assessment.…”

Section: Discussionmentioning

confidence: 99%

Peripheral nervous system injury after high-dose single-fraction image-guided stereotactic radiosurgery for spine tumors

Stubblefield

Ibanez²,

Riedel

et al. 2017

FOC

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OBJECTIVE The object of this study was to determine the percentage of high-dose (1800–2600 cGy) single-fraction stereotactic radiosurgery (SF-SRS) treatments to the spine that result in peripheral nervous system (PNS) injury. METHODS All patients treated with SF-SRS for primary or metastatic spine tumors between January 2004 and May 2013 and referred to the Rehabilitation Medicine Service for evaluation and treatment of neuromuscular, musculoskeletal, or functional impairments or pain were retrospectively identified. RESULTS Five hundred fifty-seven SF-SRS treatments in 447 patients resulted in 14 PNS injuries in 13 patients. All injures resulted from SF-SRS delivered to the cervical or lumbosacral spine at 2400 cGy. The overall percentage of SF-SRS treatments resulting in PNS injury was 2.5%, increasing to 4.5% when the thoracic spine was excluded from analysis. The median time to symptom onset following SF-SRS was 10 months (range 4–32 months). The plexus (cervical, brachial, and/or lumbosacral) was affected clinically and/or electrophysiologically in 12 (86%) of 14 cases, the nerve root in 2 (14%) of 14, and both in 6 (43%) of 14 cases. All patients experienced pain and most (93%) developed weakness. Peripheral nervous system injuries were CTCAE Grade 1 in 14% of cases, 2 in 64%, and 3 in 21%. No dose relationship between SF-SRS dose and PNS injury was detected. CONCLUSIONS Single-fraction SRS to the spine can result in PNS injury with major implications for function and quality of life.

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Section: Discussionmentioning

confidence: 99%

Peripheral nervous system injury after high-dose single-fraction image-guided stereotactic radiosurgery for spine tumors

Stubblefield

Ibanez²,

Riedel

et al. 2017

FOC

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“…The implementation of magnetic resonance neurography with diffusion‐weighted sequences appears promising in the investigation of cancer patient . In addition, 18‐FDG PET may have a supplemental role in ruling out malignancy …”

Section: Plexopathiesmentioning

confidence: 99%

“…65,89 In addition, 18-FDG PET may have a supplemental role in ruling out malignancy. 90 Also, nerve ultrasound may provide useful information in the evaluation of post-radiation plexopathy revealing reduced cross-sectional area of the irradiated plexus. 91…”

Section: Plexopathiesmentioning

confidence: 99%

Peripheral nervous system involvement in lymphomas

Briani

Visentin

Campagnolo

et al. 2019

J Peripheral Nervous Sys

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The peripheral nervous system may be involved at any stage in the course of lymphoproliferative diseases. The different underlying mechanisms include neurotoxicity secondary to chemotherapy, direct nerve infiltration (neurolymphomatosis), infections, immune‐mediated, paraneoplastic or metabolic processes and nutritional deficiencies. Accordingly, the clinical features are heterogeneous and depend on the localization of the damage (ganglia, roots, plexi, and peripheral nerves) and on the involved structures (myelin, axon, and cell body). Some clinical findings, such a focal or diffuse involvement, symmetric or asymmetric pattern, presence of pain may point to the correct diagnosis. Besides a thorough medical history and neurological examination, neurophysiological studies, cerebrospinal fluid analysis, nerve biopsy (in selected patients with suspected lymphomatous infiltration) and neuroimaging techniques (magnetic resonance neurography and nerve ultrasound) may be crucial for a proper diagnostic workup.

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“…Brachial plexopathy-associated breast cancer can occur by radiation injury or metastatic spread of the tumor [ 1 ]. This plexopathy can be detected by short tau inversion recovery (STIR) magnetic resonance (MR) imaging (MRI) and fluorodeoxyglucose positron-emission tomography (PET) [ 2 , 3 ]. On the other hand, metastasis of breast cancer is often detected through a long-term course and difficult to diagnose [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

A Case of Suspected Breast Cancer Metastasis to Brachial Plexus Detected by Magnetic Resonance Neurography

et al. 2016

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Metastasis of breast cancer is often detected through a long-term course and difficult to diagnose. We report a case of brachial plexopathy suspected to be the initial lesion of breast cancer metastasis, which was only detected by magnetic resonance (MR) neurography. A 61-year-old woman was admitted to our hospital within 2 years after operation for breast cancer because of progressive dysesthesia and motor weakness initially in the upper limb on the affected side and subsequently on the contralateral side. Enhanced computed tomography, axillary lymph node echo, gallium scintigraphy, and short tau inversion recovery MR images showed no abnormalities. MR neurography revealed a swollen region in the left brachial plexus. We suspected neuralgic amyotrophy and initiated treatment with intravenous immunoglobulin therapy and steroid therapy. However, there was no improvement, and the progression of motor weakness in the bilateral lower limbs appeared over 4 years. Concomitant elevation of carbohydrate antigen 15-3 level (58.9 U/ml) led us to suspect breast cancer metastasis, which was associated with the worsening of neurological findings, although gallium scintigraphy and bone scintigraphy showed no inflammatory and metastatic lesions. Swelling of the cauda equina in enhanced lumbar MR imaging and abnormal accumulation at the brachial plexus and cervical spinal cord in positron-emission tomography were newly detected contrary to the normal findings on the gallium scintigraphy, which suggested cerebrospinal fluid seeding. We suspected breast cancer metastasis about the initial brachial plexopathy based on the clinical course. MR neurography may be a helpful tool to detect metastatic lesion, especially in nerve roots.

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18F-FDG PET/CT Appearance of Metastatic Brachial Plexopathy Involving Epidural Space From Breast Carcinoma

Cited by 9 publications

References 6 publications

Peripheral nervous system injury after high-dose single-fraction image-guided stereotactic radiosurgery for spine tumors

Peripheral nervous system injury after high-dose single-fraction image-guided stereotactic radiosurgery for spine tumors

Peripheral nervous system involvement in lymphomas

A Case of Suspected Breast Cancer Metastasis to Brachial Plexus Detected by Magnetic Resonance Neurography

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