How to find perineural and leptomeningeal spread of tumor скачать в хорошем качестве

How to find perineural and leptomeningeal spread of tumor

In this video, Dr. Katie Bailey discusses leptomeningeal and perineural tumor, including some of the key differences between the two and how to spot them on your imaging studies using case examples. 0:00 What are leptomeningeal and perineural disease Leptomeningeal disease is cancer involving the pia or arachnoid, while perineural tumor is microscopic tumor invading and spreading along layers of the perineurium. MRI with contrast has high sensitivity for detecting both. Leptomeningeal disease looks like a coating along the surface of the brain. Many times FLAIR will also be abnormal. Perineural tumor presents as enlargement of the nerve, nerve enhancement, and often invasion of the perineural fat. 1:56 Case 1: Nasopharyngeal squamous cell carcinoma This is a patient with a case of nasopharyngeal SCC. You can see abnormal FLAIR along the surface of the right midbrain and pons as well as the left cerebellum, where there is associated enhancement. This is leptomeningeal spread of nasopharyngeal cancer. 2:38 Case 2: Metastatic urothelial carcinoma In this case, there is abnormal FLAIR along the left trigeminal cistern (Meckel’s cave), with abnormal nodular thickening and enhancement in the region. 3:22 Case 3: Squamous cell carcinoma of the masticator space This case has an irregular mass in the right infratemporal fossa with peripheral enhancement. There is abnormal FLAIR and enhancement along the right Meckel’s cave along the right 5th cranial nerve. 4:12 Case 4: Parotid carcinoma This case has a normal parotid gland on the left, with an irregular mass in the parotid gland on the right. Whenever you see a parotid mass, you should look at the facial nerve, which is a primary site of facial nerve spread. The facial nerve should not enhance in the internal auditory canal, and this case shows some perineural spread of tumor at the geniculate ganglion and in the internal auditory canal. 5:22 Case 5: Metastatic melanoma The FLAIR shows abnormal hyperintensity in the sulci near the vertex with associated nodular enhancement. On the sagittal imaging, there is nodular enhancement in the inferior frontal gyri, along the surface of the midbrain, and along the surface of the cerebellum. You should not see vascular enhancement along the cerebellum and surface of the brainstem. 6:42 Case 6: History withheld This case has thickening along the right maxillary sinus, with loss of the normal fat planes and a mass involving the right maxillary gingival region. You can see that the infraorbital foramen is bigger on the right compared to the left, which is suspicious for spread of tumor along the V2 segment of the trigeminal nerve. The MRI shows diffuse enlargement of the nerve with enhancement. 8:49 Summary Thanks for tuning in to this video on leptomeningeal disease and perineural spread of tumor. Check out the rest of the head and neck content at our website https://learnneuroradiology.com/headn... or the head and neck YouTube Playlist    • Cervical Lymph Node Stations - a landmark ...   Check out this video and additional content on http://www.learnneuroradiology.com