MRI brain pathology - leptomeningeal carcinomatosis

I have seen this diagnosis a lot lately.  Patients will present VERY sick. These patients present with differing degrees of incapacity.  Some patients have known cancer and others have no known primary.  Mental status changes, inability to walk or perform everyday tasks.  Some patients can still communicate but limited and some present completely incapacitated.  Some cases that have no known primary, the physician may initially think the patient has a metabolic imbalance.Breast, lung and lymphoma are some of the most common cancers that will progress to this state.

Leptomeningeal carcinomatosis will show a large amount of meningeal enhancement with metastatic enhancement to the white matter of the brain also in some cases.  These patients outcomes are usually very grim.  This diagnosis is usually made towards the end of their life.  It is very sad when these images come across your monitor.

The following is a useful link I found which thoroughly describes the enhancement within the different layers of the brain:  http://emedicine.medscape.com/article/1156338-overview

Patient #1.  T1 Sagital pre contrast

Patient #1.  T1 Sagital post contrast.  See the leptomeningeal enhancement.

Patient #2.  T2 Axial.  Note the area of the thalamus and surrounding areas.  Not much to notice on the T2 image, but slight hyperintensity in this area compared to normal.

Patient #2.  T1 Axial pre contrast.

Patient #2.  T1 Axial post contrast.  See the white matter enhancement.