PMC3037324_01
Axial magnetic resonance imaging (MRI) scan at three different occasions. Images (A-C) show the initial MRI with a large right-sided supratentorial meningeal tumor (arrows) with extensive surrounding edema (bright signal, C). D) MRI after treatment with gamma knife shows marked reduction of the tumor size with only little residual tumor (arrow). E-F) MRI six months from the start of symptoms shows leptomeningeal metastases with linear contrast enhancement along the cerebellar sulci (arrows).
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F1
The meningeal mass was surrounded by extensive edema of the right parietal lobe (Figure 1A-C). MRI control 13 days after treatment with gamma knife showed marked reduction of the volume of the intracranial meningeal tumor (Figure 1D). A planned MRI of the brain about six months after the onset of symptoms showed evidence of cerebellar leptomeningeal enhancement (Figures 1E and 1F), which was immediately treated with 30 Gy of palliative radiation therapy.
Magnetic resonance imaging (MRI) scan of the lumbar spine eight months after the onset of symptoms. T2-weighted (A) and T1-weighted (B-C) images before and after contrast administration show mild contrast enhancing multilobular tumors in the epidural fat behind the dural sac at the level of L3-L4 (black arrows) and a dural sac filled with intradural tumors (white arrows). Note the absence of the normal cerebrospinal fluid signal in the dural sac below the medullary conus. Axial T1-weighted images before (D) and after (E) contrast administration show the epidural metastases lateral and dorsal to the dural sac (black arrows in D; arrowheads in E). The white arrow in E shows the dorsal limit of the dural sac. F) Axial T1-weighted image after contrast administration shows a tumor-filled dural sac (white arrows).
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F2
Emergency MRI of the spine and the spinal canal showed that the dural sac between the first and fifth lumbar vertebra was filled with intradural tumor masses with mild contrast enhancement (Figures 2A to 2F).