Miliary cerebral metastases: prevalence and radiological findings

Year 2023, Volume: 6 Issue: 5, 865 - 869, 28.09.2023

Ezel Yaltırık Bilgin Özkan Ünal

https://doi.org/10.32322/jhsm.1320975

Abstract

Aims: Miliary cerebral metastases, also known as carcinomatosis encephalitis, represent an unusual form of metastatic disease in the brain. Due to their rarity, limited literature is available, restricting our understanding of this condition. This study aimed to evaluate the prevalence and imaging characteristics of miliary cerebral metastases in a cohort of metastatic patients.
Methods: A retrospective review was conducted on approximately 618 contrast-enhanced MRI scans from patients with metastatic disease who had not undergone surgical intervention or received radiotherapy. Cases of miliary cerebral metastases were identified and analyzed. Demographic data, primary cancer types, non-contrast CT and MRI findings of miliary metastasis cases were evaluated.
Results: Miliary cerebral metastases were identified in 6 out of the 618 metastatic patients included in the study. The radiological features included small, disseminated hyperintense lesions visible on post-contrast T1-weighted images. These lesions were diffusely scattered throughout the brain, predominantly at the grey-white matter junction.
Conclusion: Our findings highlight the rarity of miliary cerebral metastases, supporting the limited cases reported in the literature. These findings underscore the need for increased clinical awareness and further research into this condition. High-resolution, contrast-enhanced MRI plays a vital role in detecting and characterizing miliary cerebral metastases, aiding in their management.

Keywords

Miliary cerebral metastases, carcinomatosis encephalitis, metastatic disease, MRI, brain metastases

References

• Bhushan C. "Miliary" metastatic tumors in the brain. Case report. J Neurosurg. 1997;86(3):564-5 66.
• Nemzek W, Poirier V, Salamat MS, Yu T. Carcinomatous encephalitis (miliary metastases): lack of contrast enhancement. AJNR Am J Neuroradiol. 1993;14(3):540-542.
• Ogawa M, Kurahashi K, Ebina A, Kaimori M, Wakabayashi K. Miliary brain metastasis presenting with dementia: progression pattern of cancer metastases in the cerebral cortex. Neuropathology. 2007;27(4):390-395.
• Bashour SI, Ibrahim NK, Schomer DF, et al. Central nervous system miliary metastasis in breast cancer: a case series analysis and proposed identification criteria of a rare metastasis subtype. Br J Cancer. 2020;123(9):1417-1423.
• Divya KP, Cherian A, Prabhakaran PK, Thomas B, Shetty K. Calcific miliary brain metastasis in adenocarcinoma lung treated with gefitinib. Neurol India. 2022;70(3):1197-1199.
• Huang Z, Xie D, Yang P, et al. Miliary brain metastases from lung adenocarcinoma as non-enhancing lesions on MRI: a case report and literature review. Transl Cancer Res. 2021;10(2):1162-1168.
• Inomata M, Hayashi R, Kambara K, et al. Miliary brain metastasis presenting with calcification in a patient with lung cancer: a case report. J Med Case Rep. 2012;6:279.
• Khan D, Danjuma M, Saddique MU, Murshed KAH, Yassin MA. Adenocarcinoma of the lung mimicking miliary tuberculosis. Case Rep Oncol. 2020;13(1):139-144.
• Mills MN, Ahmed KA. Miliary breast cancer brain metastasis: a rare and aggressive form of central nervous system metastasis. Br J Cancer. 2020;123(9):1349-1350.
• Eraky AM. Radiological biomarkers for brain metastases prognosis: quantitative magnetic resonance imaging (MRI) modalities as non-invasive biomarkers for the effect of radiotherapy. Cureus. 2023;15(4):e38353.
• Niranjan A, Monaco E, Flickinger J, Lunsford LD. Guidelines for multiple brain metastases radiosurgery. Prog Neurol Surg. 2019;34:100-109.
• Khan D, Saddique MU, Paul T, Murshed K, Zahid M. Metastatic adenocarcinoma of the lung mimicking miliary tuberculosis and Pott's disease. Cureus. 2021;13(1):e12869.
• Rajendran S, Lee JJ, Le HB, Britz G. Miliary pattern in secondary central nervous system T-cell lymphoma. Surg Neurol Int. 2022;13:25.
• Rivas E, Sanchez-Herrero J, Alonso M, et al. Miliary brain metastases presenting as rapidly progressive dementia. Neuropathology. 2005;25(2):153-158.
• Floeter MK, So YT, Ross DA, Greenberg D. Miliary metastasis to the brain: clinical and radiologic features. Neurology. 1987;37(11):1817-1818.
• Iguchi Y, Mano K, Goto Y, Nakano T, Nomura F, Shimokata T, et al. Miliary brain metastases from adenocarcinoma of the lung: MR imaging findings with clinical and post-mortem histopathologic correlation. Neuroradiology. 2007;49(1):35-39.
• Shirai H, Imai S, Kajihara Y, et al. MRI in carcinomatous encephalitis. Neuroradiology. 1997;39(6):437-440.
• Hiya S, Fujiwara S, Nakagawa A, et al. Isolated progression of miliary brain metastasis in a patient with stable lung adenocarcinoma successfully treated with whole-brain radiotherapy: a case report. eNeurologicalSci. 2021;25:100366.
• Kurihara M, Koda H, Aono H, et al. Rapidly progressive miliary brain metastasis of lung cancer after EGFR tyrosine kinase inhibitor discontinuation: an autopsy report. Neuropathology. 2019;39(2):147-155.
• Kahveci R, Gurer B, Kaygusuz G, Sekerci Z. Miliary brain metastases from occult lung adenocarcinoma: Radiologic and histopathologic confirmation. J Neurosci Rural Pract. 2012;3(3):386-389.
• Koyyala VPB, Goyal S, Jajodia A, et al. Miliary brain metastasis-a rare pattern of metastases from breast cancer. South Asian J Cancer. 2020;9(3):188-189.
• Santos Vazquez G, Garcia Cazarez R, Moreno Pizarro E, Serrano Padilla AE, Plascencia Salcedo JC. Central nervous system miliary brain metastasis secondary to breast cancer. Cureus. 2020;12(8):e9649.
• Bekiesińska-Figatowska M, Kuczyńska-Zardzewiały A, Klepacka T, et al. Miliary brain metastases from papillary adenocarcinoma of the lung- unusual MRI pattern with histopathologic correlation. Pol J Radiol. 2013;78(3):57-60.