Most common sites on MRI of intracranial neoplastic leptomeningeal disease

Debnam, J. Matthew; Mayer, Rory R.; Linda, T.; Ketonen, Leena; Weinberg, Jeffrey S.; Wei, Wei; Groves, Morris D.; Guha-Thakurta, Nandita

doi:10.1016/j.jocn.2017.07.020

Cited by 21 publications

(12 citation statements)

References 28 publications

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“…In our experience, both neurolymphomatosis and PNS from other tumors is more challenging to detect with MRI on V 1 than on V 2 . This may be related to the fact that V 1 courses through the superior orbit and is in close proximity to the superior rectus/levator palpebrae complex and may be difficult to visualize on MRI.. Another potential explanation for the more common involvement of V 2 than of V 1 in our study is the finding, demonstrated by multiple authors [ 18 – 20 ], that LMD occurs more commonly in dependent portions of the brain. This possibility could be the topic of further investigation.…”

Section: Discussionmentioning

confidence: 75%

Primary disease sites and patterns of spread in cases of neurolymphomatosis in the orbit associated with lymphoma

et al. 2021

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Background Neurolymphomatosis involving the cranial nerves (CNs) is rare. We sought a better understanding of the primary disease sites and patterns of spread in neurolymphomatosis of the orbit and retro-orbital cranial nerves. Methods Patients with lymphoma and MRI evidence of neurolymphomatosis of CN II, III, IV, V1, or V2 were retrospectively reviewed. Demographics and primary disease site and sites of neurolymphomatosis on MRI were recorded. Wilcoxon rank sum test was used to compare number of sites of neurolymphomatosis with lymphoma type and survival. Results The study included 18 patients. The most frequent types of lymphoma were diffuse large B-cell (DLBCL) (n = 9) and marginal zone (n = 3). In 9 patients, lymphoma presented as a mass (n = 7) or infiltrative disease (n = 2) directly involving the orbit; in 6, a maxillofacial mass spread directly to CNs; and in 3, lymphoma at remote sites spread to orbital CNs. Overall, 81 sites of neurolymphomatosis were noted. The most common sites were the maxillary nerve (V2) including at the infraorbital fissure or foramen rotundum (17 patients; 19 nerves), pterygopalatine fossa (16 patients; 19 nerves), and cavernous sinus (9 patients; 12 nerves). Number of sites of neurolymphomatosis was significantly lower for DLBCL than for other lymphoma types (p = 0.007). Number of sites of neurolymphomatosis did not affect survival (p = 0.26). The mean interval between the pathologic diagnosis and MRI documentation of the full extent of neurolymphomatosis was 39 days after pathologic diagnosis. Conclusions Based on our study results, neurolymphomatosis in the orbit appears to be frequently associated with an orbital and/or maxillofacial mass and commonly involves CN V2, the pterygopalatine fossa, and the cavernous sinus. DLBCL may be associated with fewer sites of neurolymphomatosis than other lymphomas. In patients with lymphoma, a systematic search for neurolymphomatosis is imperative for early detection.

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Section: Discussionmentioning

confidence: 75%

Primary disease sites and patterns of spread in cases of neurolymphomatosis in the orbit associated with lymphoma

et al. 2021

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“…[13] When CSF cytology is negative, means such as CEA or other such biological markers can provide adjunct diagnosis, but there is no consensus as to cutoff values. Contrast-enhanced T1 or FLAIR diagnostic imaging is known to provide a high signal in the cerebellum or occipital lobe in 25%-35% of CSF cytology-positive patients, [14] while impaired absorption is known to represent occurrence of hydrocephalus. In the current case, CSF cytology was negative, but selective IR-pulsed MRI allowed diagnosis of meningeal dissemination after demonstrated CSF interchange at the third ventriculostomy, concomitant with aggravated hydrocephalus, and contrast enhancement of areas, including the ventricular wall of the left hypothalamus and the cerebellar fissure.…”

Section: Discussionmentioning

confidence: 99%

Diplopia presenting in a case of pineal metastasis of pulmonary sarcomatoid carcinoma refractory to treatment

et al. 2020

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A 42-year-old male presented with diplopia, headache, and nausea. Magnetic resonance imaging (MRI) of the brain showed pineal tumor, and chest computed tomography (CT) demonstrated a lung tumor. Disorientation developed, with occurrence of hydrocephalus, and we performed neuroendoscopic surgery for biopsy of the pineal tumor and third ventriculostomy. The lung tumor was biopsied under bronchoscopic and CT guidance, and based on the pathological results, we diagnosed pineal metastasis of pulmonary sarcomatoid carcinoma (cT3N1M1b Stage IVA). Stereotactic radiotherapy for the metastatic pineal tumor and systemic chemotherapy (carboplatin + pemetrexed) were pursued, but hemorrhage of the tumor occurred, hydrocephalus worsened, and neoplastic meningitis was diagnosed by MRI. Therapy was switched to nivolumab, but without effect, and the patient succumbed. Even among lung tumors, sarcomatoid carcinoma is rare. There are also few reports of lung tumors metastasized to the pineal gland. Our case report of pineal tumor regarded as metastasis of pulmonary sarcomatoid carcinoma also includes a discussion of the literature.

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“…We measured ADC values of CSF (ADC CSF ) by manually placing regions of interest (ROIs) (at least 1cm in diameter) within posterior lateral ventricle body to avoid choroid plexus areas. Posterior lateral ventricle was preferred due to predominantly involvement of posterior areas in gravity-dependent regions according to Debnam study (7). ROIs were placed within lateral pterigoid muscle (LPM) to measure ADC value of LPM (ADC LPM ) in order to use it as a reference area outside of the brain (Figure 3).…”

Section: Mr Imaging and Analysismentioning

confidence: 99%

“…Leptomeningeal enhancement appears as a streakly pattern on MRI. Contrast enhanced T1 weighted image (WI) have long been the technique of choice for evaluating LMC (7). LMC can be easily visualized on CE FLAIR sequence allows for a clearer distinction between enhancing meninges ans enhancing cortical veins becoming less clearly enhanced on FLAIR images (8).…”

Section: Introductionmentioning

confidence: 99%

Lateral Ventrikül Görünür Difüzyon Katsayısı Leptomeningeal Karsinomatozis Tanısında Yararlı Olabilir mi?

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Toprak²

2020

Osmangazi̇ Journal of Medicine

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Leptomeningeal carcinomatosis (LMC) is caused by the spread of malignant cells within cerebrospinal fluid (CSF). Diffusion-weighted imaging (DWI) is quantified by the apparent diffusion coefficient (ADC) value. The decreased ADC of CSF in pyogenic ventriculitis due to pleocytosis and the protein content has been reported. With similar argument, we hypothesized ADC in LMC can be decreased due to higher CSF viscosity caused by levated factors such as cell count, total protein. The purpose of our study was to evaluate whether increased CSF viscosity in LMC causes low ADC values in CSF. Thirty-one patients with LMC and 31 age and sex-matched subjects having normal brain MRI were included in this study. ADC measurements were made on both sides in posterior lateral ventricle (LV) and lateral pterigoid muscle (LPM). The ADC ratio (=ADCCSF/ADCLPM) was calculated by dividing the ADC values to prevent individual and device-dependent differences. ADCCSF and ADC ratios were compared between the groups. Both the ADCCSF and ADCCSF/ADCLPM ratio in the LMC group was lower than those in the control group with statistical significance. ROC analysis showed a cutoff value of 2844 for the ADCCSF (sensitivity 51.61%, specificity 96.77%, under curve 0.800) and a cutoff value of 1.97 for the ADC ratio (sensitivity 74.19%, specificity 93.55%, under curve 0.833) for differentiating LMC and control groups. ADC value may be used as a complementary tool to increase diagnostic accuracy of LMC.

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Most common sites on MRI of intracranial neoplastic leptomeningeal disease

Cited by 21 publications

References 28 publications

Primary disease sites and patterns of spread in cases of neurolymphomatosis in the orbit associated with lymphoma

Primary disease sites and patterns of spread in cases of neurolymphomatosis in the orbit associated with lymphoma

Diplopia presenting in a case of pineal metastasis of pulmonary sarcomatoid carcinoma refractory to treatment

Lateral Ventrikül Görünür Difüzyon Katsayısı Leptomeningeal Karsinomatozis Tanısında Yararlı Olabilir mi?

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