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Background <p>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.</p> Case presentation <p>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⁻<sup>3</sup> mm<sup>2</sup>/s. Cerebrospinal fluid (CSF) cytology confirmed LM. These findings, termed the “bloomy rind sign”, may represent an alternative LM pattern.</p> Conclusion <p>Recognizing atypical LM imaging may improve diagnosis and guide management.</p>

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

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月13日

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  • Ahmet Malkoçoğlu,
  • Nisa Başpınar

摘要

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.