MRI - MRI brain
Axial FLAIR
Ax T2 FSE S
Axial T1
Sagittal T1
Axial Echo planar
Axial T1 C+
Coronal T1 C+
Prior left-sided parietal craniotomy is noted, with no subjacent changes to suggest tumour recurrence. A small amount of dural thickening is in keeping with expected post-operative change. The degree of T2 signal hyperintensity within the right occipital lobe as also are almost entirely resolved, with no abnormal enhancement in this region.
On a number of images, particularly on axial postcontrast T1 weighted sequences, there is increased leptomeningeal enhancement, particularly around the medulla and enhancement of cranial nerves (particularly the 6th cranial nerves bilaterally).
The brain is unremarkable, with no intra extra-axial collection or mass evident.
Conclusion:
Prominent leptomeningeal enhancement in this clinical setting is concerning for leptomeningeal carcinomatosis.