A new and rare magnetic resonance ımaging finding of leptomeningeal metastasis: “bloomy rind sign”

Creative Commons License

MALKOÇOĞLU A., BAŞPINAR N.

Egyptian Journal of Neurology, Psychiatry and Neurosurgery, cilt.61, sa.1, 2025 (ESCI) identifier

  • Yayın Türü: Makale / Tam Makale
  • Cilt numarası: 61 Sayı: 1
  • Basım Tarihi: 2025
  • Doi Numarası: 10.1186/s41983-025-01034-8
  • Dergi Adı: Egyptian Journal of Neurology, Psychiatry and Neurosurgery
  • Derginin Tarandığı İndeksler: Emerging Sources Citation Index (ESCI), Scopus, Academic Search Premier, Arab World Research Source, EMBASE, Directory of Open Access Journals
  • Anahtar Kelimeler: Adenocarcinoma, Bloomy rind sign, Leptomeningeal metastasis, Lung cancer, MRI
  • Sivas Cumhuriyet Üniversitesi Adresli: Evet

Özet

Background: Magnetic Resonance Imaging (MRI) is key in diagnosing leptomeningeal metastasis (LM). While subarachnoid nodules and pial enhancement are common MRI findings, atypical Fluid-attenuated Inversion Recovery (FLAIR) and Diffusion-weighted Imaging (DWI) abnormalities are rare. Case presentation: A 66-year-old male with lung adenocarcinoma had persistent headaches, nausea, and vomiting. MRI showed symmetric band-like FLAIR hyperintensity from the pons to the middle cerebellar peduncle and diffusion restriction on DWI, without pathological enhancement. Mean Apparent Diffusion Coefficient (ADC) value within this region was 0.524 × 10⁻3 mm2/s. Cerebrospinal fluid (CSF) cytology confirmed LM. These findings, termed the “bloomy rind sign”, may represent an alternative LM pattern. Conclusion: Recognizing atypical LM imaging may improve diagnosis and guide management.