Malign Solid Tümörlerin İntrakraniyal Leptomeningeal Metastazları; Klinik ve Manyetik Rezonans Görüntüleme Bulguları

Year 2020, Volume: 42 Issue: 2, 121 - 129, 17.03.2020

Esin Kurtuluş Öztürk Saffet Öztürk Suzan Şaylısoy Bülent Yıldız

https://doi.org/10.20515/otd.445091

Abstract

Bu çalışmada malign solid tümörlerin
intrakraniyal leptomeningeal metastazlarının klinik ve manyetik rezonans
görüntüleme (MRG) bulgularını literatür bilgileri eşliğinde sunmayı amaçladık.
Ocak 2015 ile Nisan 2018 arasında farklı primer solid malignitelere sahip
leptomeningeal metastaz tanısı olan 32 hasta çalışmaya dahil edildi. Hastaların
klinik ve kontrastlı beyin MRG incelemeleri retrospektif değerlendirildi.
Hastaların demografik özellikleri, primer maligniteleri, klinik ve MRG
bulguları kaydedildi. MRG görüntülerde leptomeningeal metastazların
lokalizasyonu ve kontrastlanma paterni, kraniyal sinir tutulumu, hidrosefali ve
subependimal nodül varlığı değerlendirildi. Leptomeninkste metastazı en sık
yapan malign solid tümörler akciğer (%53.1) ve meme (%25) karsinomlarıydı. En
sık semptom baş ağrısı ve bilinç değişikliğiydi. Çoğunlukla infratentoryal ve
supratentoryal (%50) alanların birlikte tutulumu mevcuttu. Kontrastlı MRG’de
kontrastlanma çoğunlukla nodüler paternde (%53.1) izlendi. Kraniyal sinir
tutulumu nadir saptanmakla birlikte en sık 7. ve 8. kraniyal sinir tutulumu
mevcuttu. Hidrosefali (%43.8) ve parankimal metastaz (%87.5) sık saptandı.
Leptomeningeal metastazlarda klinik ve radyolojik görüntüleme özelliklerinin
bilinmesi doğru tanı, uygun tedavi ve doğru hastalık yönetimine olanak sağlar. 

Keywords

Leptomeningeal metastaz, malign solid tümör, kanser, manyetik rezonans görüntüleme

Intracranial Leptomeningeal Metastases of Malign Solid Tumors; Clinical and Magnetic Resonance Imaging Findings

Abstract

We aimed to present
clinical and magnetic resonance imaging (MRI) findings of intracranial
leptomeningeal metastases of malign solid tumors with literature.Between
January 2015 and April 2018, 32 patients with histopathologically proven
different primary solid malignancies and diagnosis of leptomeningeal metastases
were included in this study. We retrospectively analyzed the clinical and
contrast-enhanced MRI findings of patients. We documented demographic
characteristics, primary malignancies, clinical and MRI findings. We evaluated
localization and enhancement pattern of leptomeningeal metastases, cranial
nerve involvement, presence of hydrocephalus and presence of subependymal
nodule on MRI. The most common malign solid tumors with leptomeningeal
metastases were lung (53.1%) and breast (25%) carcinomas. The most common
presenting symptoms were headache and altered consciousness. Leptomeningeal
metastases were mostly located in both infratentorial and supratentorial areas
(50%).On contrast-enhanced MR images nodular enhancement pattern (53.1%) was
mostly observed. Although cranial nerve involvement was rarely detected,
cranial nerve involvement was most frequently observed in the 7th and 8th
cranial nerves. Hydrocephalus (43.8%) and parenchymal metastasis (87.5%) were
quite common. Knowledge of clinical and radiological imaging features in
leptomeningeal metastases allows accurate diagnosis, appropriate treatment and
disease management.

Keywords

leptomeningeal metastases, malign solid tumor, carcinoma, magnetic resonance imaging

References

• Kaynaklar
• 1. Kesari S, Batchelor TT. Leptomeningeal metastases. Neurol Clin. 2003;21(1):25-66.2. Kaplan JG, DeSouza TG, Farkash A, Shafran B, Pack D, Rehman F, et al. Leptomeningeal metastases: comparison of clinical features and laboratory data of solid tumors, lymphomas and leukemias. J Neurooncol. 1990;9(3):225-9.3. Le Rhun E, Taillibert S, Chamberlain MC. Carcinomatous meningitis: Leptomeningeal metastases in solid tumors. Surg Neurol Int. 2013;4(Suppl 4):S265-88.4. Taillibert S, Laigle-Donadey F, Chodkiewicz C, Sanson M, Hoang-Xuan K, Delattre JY. Leptomeningeal metastases from solid malignancy: a review. J Neurooncol. 2005;75(1):85-99.5. Leal T, Chang JE, Mehta M, Robins HI. Leptomeningeal Metastasis: Challenges in Diagnosis and Treatment. Curr Cancer Ther Rev. 2011;7(4):319-27.6. Jaeckle KA. Neoplastic meningitis from systemic malignancies: diagnosis, prognosis and treatment. Semin Oncol. 2006;33(3):312-23.7. Clarke JL, Perez HR, Jacks LM, Panageas KS, Deangelis LM. Leptomeningeal metastases in the MRI era. Neurology. 2010;74(18):1449-54.8. Singh SK, Leeds NE, Ginsberg LE. MR imaging of leptomeningeal metastases: comparison of three sequences. AJNR Am J Neuroradiol. 2002;23(5):817-21.9. Collie DA, Brush JP, Lammie GA, Grant R, Kunkler I, Leonard R, et al. Imaging features of leptomeningeal metastases. Clin Radiol. 1999;54(11):765-71.10. Freilich RJ, Krol G, DeAngelis LM. Neuroimaging and cerebrospinal fluid cytology in the diagnosis of leptomeningeal metastasis. Ann Neurol. 1995;38(1):51-7.11. Debnam JM, Mayer RR, Chi TL, Ketonen L, Weinberg JS, Wei W, et al. Most common sites on MRI of intracranial neoplastic leptomeningeal disease. J Clin Neurosci. 2017;45:252-6.