IMAGE OF THE WEEK 2012
WEEK 24
Leptomeningeal metastases
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Figure 1: CT scan of the brain showing contrast enhancement of the leptomeninges as "icing sugar coating", indicated by the white arrows. (Click to enlarge picture) |
Figure 2: CT scan of the brain showing contrast enhancement of the leptomeninges as "icing sugar coating", indicated by the white arrows. (Click to enlarge picture) |
Leptomeningeal metastases are the spread of malignant cells through the cerebrospinal fluid – this can be either from a primary CNS tumour or more commonly from a distant primary tumour. The metastatic deposits may be within the brain or ‘coated’ along the leptomeninges of the spinal cord.
The clinical presentation may be quite non-specific, such as headache or being ‘out of sorts’.
Leptomeningeal metastases are best and often only identified after a post contrast imaging study – either CT or MRI. The latter is most sensitive, most commonly appreciated as linear enhancement over the leptomeninges in an ‘icing sugar coating’, like that over the top of a cake (Figures 1 & 2).
The commonest primary tumours associated with leptomeningeal metastases are lung and breast cancer, but can occur in other tumours, such as melanoma (Figure 3).
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Figure 3: CT scan of the chest showing a left T4 NSCLC with a right middle lobe metastasis. (Click to enlarge picture) |
Images and text contributed and prepared by
Dr Ian Bickle, Department of Radiology,
All images are copyrighted and property of RIPAS Hospital.
