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Leptomeningeal Carcinomatosis: Multimedia

Author: Andrew L Wagner, MD, Assistant Professor of Radiology, Instructional Faculty, University of Virginia School of Medicine; Director of Neuroradiology, Department of Radiology, Rockingham Memorial Hospital
Contributor Information and Disclosures

Updated: Feb 1, 2007

Multimedia

Axial T1-weighted postcontrast image demonstrates...
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Media file 1: Axial T1-weighted postcontrast image demonstrates diffuse enhancement of the basal cisterns and leptomeninges from metastatic pilocytic astrocytoma. This appearance has been referred to as "zuckerguss" or sugar icing. In children, primitive neuroectodermal tumors are the most common cause of leptomeningeal carcinomatosis, but pilocytic astrocytomas (which are generally low grade) occasionally can demonstrate this type of aggressive behavior.
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Axial T1-weighted postcontrast image demonstrates...

Axial T1-weighted postcontrast image demonstrates diffuse enhancement of the basal cisterns and leptomeninges from metastatic pilocytic astrocytoma. This appearance has been referred to as "zuckerguss" or sugar icing. In children, primitive neuroectodermal tumors are the most common cause of leptomeningeal carcinomatosis, but pilocytic astrocytomas (which are generally low grade) occasionally can demonstrate this type of aggressive behavior.

Sagittal T1-weighted postcontrast MR through the ...
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Media file 2: Sagittal T1-weighted postcontrast MR through the cervical spine in the same patient as Image 1. Note the diffuse enhancement of the subarachnoid space from extensive tumor deposits. Enhancing material surrounds the cord with no cerebrospinal fluid visible, giving the appearance of a T2 image. Marrow changes are consistent with prior radiation and/or chemotherapy.
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Sagittal T1-weighted postcontrast MR through the ...

Sagittal T1-weighted postcontrast MR through the cervical spine in the same patient as Image 1. Note the diffuse enhancement of the subarachnoid space from extensive tumor deposits. Enhancing material surrounds the cord with no cerebrospinal fluid visible, giving the appearance of a T2 image. Marrow changes are consistent with prior radiation and/or chemotherapy.

Axial T1-weighted image postcontrast at the level...
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Media file 3: Axial T1-weighted image postcontrast at the level of the inferior cerebellar peduncles demonstrates a more subtle case of leptomeningeal carcinomatosis, with faint thin enhancing tumor covering the peduncles and medulla (arrows). Note enhancement of cranial nerves IX and X on each side (arrowheads). This was a patient with leptomeningeal spread of a glioblastoma multiforme.
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Axial T1-weighted image postcontrast at the level...

Axial T1-weighted image postcontrast at the level of the inferior cerebellar peduncles demonstrates a more subtle case of leptomeningeal carcinomatosis, with faint thin enhancing tumor covering the peduncles and medulla (arrows). Note enhancement of cranial nerves IX and X on each side (arrowheads). This was a patient with leptomeningeal spread of a glioblastoma multiforme.

Sagittal T1-weighted postcontrast image of the lu...
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Media file 4: Sagittal T1-weighted postcontrast image of the lumbar spine with fat saturation reveals diffuse tumor seeding of the cauda equina from metastatic squamous cell carcinoma. Tiny tumor foci give a "string of beads" appearance to some of the nerve roots.
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Sagittal T1-weighted postcontrast image of the lu...

Sagittal T1-weighted postcontrast image of the lumbar spine with fat saturation reveals diffuse tumor seeding of the cauda equina from metastatic squamous cell carcinoma. Tiny tumor foci give a "string of beads" appearance to some of the nerve roots.

Sagittal T1 postcontrast image through the lumbar...
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Media file 5: Sagittal T1 postcontrast image through the lumbar spine in this patient with small cell lung carcinoma demonstrates enhancing foci in the cauda equina and adjacent to the conus (arrows). In addition, notice the finely enhancing nerve root at the S1-2 level (arrowhead). This patient was experiencing lower extremity weakness.
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Sagittal T1 postcontrast image through the lumbar...

Sagittal T1 postcontrast image through the lumbar spine in this patient with small cell lung carcinoma demonstrates enhancing foci in the cauda equina and adjacent to the conus (arrows). In addition, notice the finely enhancing nerve root at the S1-2 level (arrowhead). This patient was experiencing lower extremity weakness.

Postcontrast CT of a patient with metastatic lung...
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Media file 6: Postcontrast CT of a patient with metastatic lung cancer and headache demonstrates contrast enhancement along the right parietal sulci with bilateral cortical edema.
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Postcontrast CT of a patient with metastatic lung...

Postcontrast CT of a patient with metastatic lung cancer and headache demonstrates contrast enhancement along the right parietal sulci with bilateral cortical edema.

Postcontrast fluid attenuated inversion recovery ...
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Media file 7: Postcontrast fluid attenuated inversion recovery image demonstrates the use of this sequence in leptomeningeal carcinomatosis. Enhancement of the subarachnoid space is present scattered over both hemispheres, but most pronounced along the right parietal lobe in this patient with metastatic lung carcinoma.
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Postcontrast fluid attenuated inversion recovery ...

Postcontrast fluid attenuated inversion recovery image demonstrates the use of this sequence in leptomeningeal carcinomatosis. Enhancement of the subarachnoid space is present scattered over both hemispheres, but most pronounced along the right parietal lobe in this patient with metastatic lung carcinoma.

Axial T1 postgadolinium in the same patient as Im...
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Media file 8: Axial T1 postgadolinium in the same patient as Image 5 does not show the leptomeningeal tumor. Postcontrast fluid attenuated inversion recovery has been shown to be more sensitive than routine postcontrast T1 sequences in the detection of leptomeningeal carcinomatosis.
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Axial T1 postgadolinium in the same patient as Im...

Axial T1 postgadolinium in the same patient as Image 5 does not show the leptomeningeal tumor. Postcontrast fluid attenuated inversion recovery has been shown to be more sensitive than routine postcontrast T1 sequences in the detection of leptomeningeal carcinomatosis.

Coronal T1 postcontrast image demonstrates metast...
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Media file 9: Coronal T1 postcontrast image demonstrates metastatic disease in this patient whose breast cancer was thought to be cured. Metastatic spread can occur decades after the initial tumor has been treated. Leptomeningeal carcinomatosis from a second primary is another possibility, and central nervous system spread of melanoma or lung cancer could have this appearance. Sarcoid also can demonstrate leptomeningeal spread.
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Coronal T1 postcontrast image demonstrates metast...

Coronal T1 postcontrast image demonstrates metastatic disease in this patient whose breast cancer was thought to be cured. Metastatic spread can occur decades after the initial tumor has been treated. Leptomeningeal carcinomatosis from a second primary is another possibility, and central nervous system spread of melanoma or lung cancer could have this appearance. Sarcoid also can demonstrate leptomeningeal spread.

More on Leptomeningeal Carcinomatosis

Overview: Leptomeningeal Carcinomatosis
Imaging: Leptomeningeal Carcinomatosis
Follow-up: Leptomeningeal Carcinomatosis
Multimedia: Leptomeningeal Carcinomatosis
References
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Further Reading

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Keywords

leptomeningeal carcinomatosis, leptomeningeal metastases, arachnoid metastases, zuckerguss, LC

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Contributor Information and Disclosures

Author

Andrew L Wagner, MD, Assistant Professor of Radiology, Instructional Faculty, University of Virginia School of Medicine; Director of Neuroradiology, Department of Radiology, Rockingham Memorial Hospital
Andrew L Wagner, MD is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, American Society of Neuroradiology, and Radiological Society of North America
Disclosure: Nothing to disclose.

Medical Editor

Lucien M Levy, MD, PhD, Director of Neuroradiology, Professor of Radiology, Department of Radiology, George Washington University Medical Center
Lucien M Levy, MD, PhD is a member of the following medical societies: American Cancer Society, American College of Radiology, American Heart Association, American Medical Association, American Roentgen Ray Society, American Society of Neuroradiology, and Radiological Society of North America
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Val Runge, MD, Robert and Alma Moreton Centennial Chair in Radiology, Professor, Editor-in-Chief of Investigative Radiology, Department of Radiology, Scott and White Clinic and Hospital
Val Runge, MD is a member of the following medical societies: Society for Health and Human Values
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

James G Smirniotopoulos, MD, Professor of Radiology, Neurology, and Biomedical Informatics, Chairman, Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences
James G Smirniotopoulos, MD is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, American Society of Head and Neck Radiology, American Society of Neuroradiology, American Society of Pediatric Neuroradiology, Association of University Radiologists, and Radiological Society of North America
Disclosure: Nothing to disclose.

 
 
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