Abstract 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 mm 2 /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.
Malkoçoğlu et al. (Mon,) studied this question.