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E.1 Focal leptomeningeal vascular anomalies on brain MRI: a mimic of leptomeningeal metastatic disease

Published online by Cambridge University Press:  24 May 2024

M Malik
Affiliation:
(Toronto)*
A Yang
Affiliation:
(Toronto)
J Germann
Affiliation:
(Toronto)
SS Haile
Affiliation:
(Toronto)
H Son
Affiliation:
(Toronto)
A Vetkas
Affiliation:
(Toronto)
V Pai
Affiliation:
(Toronto)
A Boutet
Affiliation:
(Toronto)
DM Mandell
Affiliation:
(Toronto)
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Abstract

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Background: The diagnosis of leptomeningeal metastatic disease has major prognostic implications. We report 13 patients with a radiologically distinct, focal, enhancing leptomeningeal lesion on brain MRI mimicking leptomeningeal metastatic disease. Methods: These patients were assessed at University Health Network between January 2001 and December 2023. Results: Median age was 68 years and 10 patients were women. All patients had brain MRI including contrast-enhanced T2-weighted FLAIR and T1-weighted spin echo sequences. MRI in all patients showed a focal enhancing lesion along the leptomeningeal surface of the brain. The MRI exams were reported as possible metastatic disease for the majority (9/13) of patients. Each lesion was curvilinear rather than sheet-like, and some consisted of multiple connected/branching curvilinear structures with the appearance of abnormal vessels. Some lesions had visible connection with a nearby cortical vein. The lesions were distinct from normal blood vessels. Follow-up contrast-enhanced brain MRI for 8/13 patients at a median of 3.9 years showed all lesions were unchanged over time. Conclusions: We describe a distinct kind of focal, enhancing leptomeningeal lesion on brain MRI that mimics metastatic disease. These lesions are likely a type of low-flow vascular anomaly. Their curvilinear/branching shape and intense enhancement particularly on T2-weighted FLAIR images distinguishes these lesions from tumor.

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Abstracts
Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of Canadian Neurological Sciences Federation