Cranial Pachymeningeal Involvement in POEMS Syndrome: Evaluation by Pre- and Post-contrast FLAIR and T-weighted Imaging

Overview

Journal Magn Reson Med Sci

Specialty Radiology

Date 2016 Dec 23

PMID 28003622

Citations 1

Authors

Fumiaki Ueda

Miho Okuda

Hiroyuki Aburano

Yuichi Yoshie

Osamu Matsui

Toshifumi Gabata

Affiliations

Soon will be listed here.

Abstract

Purpose: To evaluate the cranial pachymeningeal involvement of polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, skin changes (POEMS) syndrome using pre- and post-contrast fluid-attenuated inversion recovery (FLAIR) and T-weighted imaging (TWI).

Methods: The appearance of pachymeningeal involvement in nine cases of POEMS syndrome was evaluated using pre- and post-contrast FLAIR and TWI. The degree of pachymeningeal thickening was graded as normal or abnormal using pre-contrast FLAIR. The degrees of contrast enhancement effect were evaluated based on pre- and post-contrast images, and recorded in each of three separate anatomical areas, i.e., the falx cerebri, cerebral convexity, and tentorium cerebelli. The degrees of contrast enhancement of pachymeninges were graded as not detected (ND), positive, or prominent on post-contrast FLAIR, and normal range (NR), positive, and prominent on post-contrast TWI.

Results: Pre-contrast FLAIR demonstrated 41% of pachymeningeal anatomical regions as areas of thickening. Post-contrast FLAIR did not detect any contrast enhancement on 26% of the regions but showed positive enhancement on 30% and prominent enhancement on 44%. Post-contrast TWI showed normal range enhancement on 48%, positive enhancement on 11%, and prominent enhancement on 41% of the regions. Post-contrast FLAIR showed the highest percentage for detection of pachymeningeal abnormalities (74%).

Conclusion: Post-contrast FLAIR may contribute to objective judgment in the evaluation of pachymeningeal involvement in POEMS syndrome.

Citing Articles

Frequent central nervous system, pachymeningeal and plexus MRI changes in POEMS syndrome.

Ziff O, Hoskote C, Keddie S, DSa S, Davangnanam I, Lunn M J Neurol. 2019; 266(5):1067-1072.

PMID: 30756171 PMC: 6469836. DOI: 10.1007/s00415-019-09233-z.

References

Krautmacher C, Willinek W, Tschampa H, Born M, Traber F, Gieseke J . Brain tumors: full- and half-dose contrast-enhanced MR imaging at 3.0 T compared with 1.5 T--Initial Experience. Radiology. 2005; 237(3):1014-9. DOI: 10.1148/radiol.2373041672. View

Briani C, Fedrigo M, Manara R, Castellani C, Zambello R, Citton V . Pachymeningeal involvement in POEMS syndrome: MRI and histopathological study. J Neurol Neurosurg Psychiatry. 2011; 83(1):33-7. DOI: 10.1136/jnnp-2011-300047. View

Dispenzieri A . POEMS syndrome. Blood Rev. 2007; 21(6):285-99. DOI: 10.1016/j.blre.2007.07.004. View

Meltzer C, Fukui M, Kanal E, Smirniotopoulos J . MR imaging of the meninges. Part I. Normal anatomic features and nonneoplastic disease. Radiology. 1996; 201(2):297-308. DOI: 10.1148/radiology.201.2.8888215. View

Kang K, Chu K, Kim D, Jeong S, Lee J, Roh J . POEMS syndrome associated with ischemic stroke. Arch Neurol. 2003; 60(5):745-9. DOI: 10.1001/archneur.60.5.745. View

Scarlato M, Previtali S, Carpo M, Pareyson D, Briani C, Del Bo R . Polyneuropathy in POEMS syndrome: role of angiogenic factors in the pathogenesis. Brain. 2005; 128(Pt 8):1911-20. DOI: 10.1093/brain/awh519. View

Briani C, Manara R, Lessi F, Citton V, Zambello R, Adami F . Pachymeningeal involvement in POEMS syndrome: dramatic cerebral MRI improvement after lenalidomide therapy. Am J Hematol. 2012; 87(5):539-41. DOI: 10.1002/ajh.23148. View

Garcia T, Dafer R, Hocker S, Schneck M, Barton K, Biller J . Recurrent strokes in two patients with POEMS syndrome and Castleman's disease. J Stroke Cerebrovasc Dis. 2007; 16(6):278-84. DOI: 10.1016/j.jstrokecerebrovasdis.2007.08.002. View

Morizane R, Sasamura H, Minakuchi H, Takae Y, Kikuchi H, Yoshiya N . A case of atypical POEMS syndrome without polyneuropathy. Eur J Haematol. 2008; 80(5):452-5. DOI: 10.1111/j.1600-0609.2008.01045.x. View

10.

Galassi W, Phuttharak W, Hesselink J, Healy J, Dietrich R, Imbesi S . Intracranial meningeal disease: comparison of contrast-enhanced MR imaging with fluid-attenuated inversion recovery and fat-suppressed T1-weighted sequences. AJNR Am J Neuroradiol. 2005; 26(3):553-9. PMC: 7976502. View

11.

Dupont S, Dispenzieri A, Mauermann M, Rabinstein A, Brown Jr R . Cerebral infarction in POEMS syndrome: incidence, risk factors, and imaging characteristics. Neurology. 2009; 73(16):1308-12. PMC: 2764416. DOI: 10.1212/WNL.0b013e3181bd136b. View

12.

Sze G, Soletsky S, Bronen R, Krol G . MR imaging of the cranial meninges with emphasis on contrast enhancement and meningeal carcinomatosis. AJNR Am J Neuroradiol. 1989; 10(5):965-75. PMC: 8335283. View

13.

Wessbecher F, Maravilla K, Dalley R . Optimizing brain MR imaging protocols with gadopentetate dimeglumine: enhancement of intracranial lesions on spin-density- and T2-weighted images. AJNR Am J Neuroradiol. 1991; 12(4):675-9. PMC: 8331569. View

14.

Farn J, Mirowitz S . MR imaging of the normal meninges: comparison of contrast-enhancement patterns on 3D gradient-echo and spin-echo images. AJR Am J Roentgenol. 1994; 162(1):131-5. DOI: 10.2214/ajr.162.1.8273651. View

15.

Goo H, Choi C . Post-contrast FLAIR MR imaging of the brain in children: normal and abnormal intracranial enhancement. Pediatr Radiol. 2003; 33(12):843-9. DOI: 10.1007/s00247-003-1057-8. View

16.

Ofran Y, Yishay O, Elinav E, Eran E . POEMS syndrome: failure of newly suggested diagnostic criteria to anticipate the development of the syndrome. Am J Hematol. 2005; 79(4):316-8. DOI: 10.1002/ajh.20384. View

17.

Dispenzieri A . POEMS syndrome: 2011 update on diagnosis, risk-stratification, and management. Am J Hematol. 2011; 86(7):591-601. DOI: 10.1002/ajh.22050. View