Citation, DOI, disclosures and article data
Citation:
Sharma R, Bloomy rind sign (leptomeningeal metastases). Reference article, Radiopaedia.org (Accessed on 05 May 2024) https://doi.org/10.53347/rID-173208
The bloomy rind sign is a radiological sign appreciated on MRI brain that is rarely but characteristically described in patients with leptomeningeal metastases (leptomeningeal carcinomatosis).
The sign describes the appearance of a curvilinear T2/FLAIR hyperintensity on the brainstem surface, typically affecting the pons anteriorly 1-6. This high signal can also appreciated on DWI, with corresponding low signal on ADC, but notably does not correspond with any accompanying contrast (gadolinium) enhancement 1-6. This 'layer' of T2/FLAIR hyperintensity, against the normal signal of the brainstem, has been likened to the bloomy rind coating the surface on certain cheeses 1,2,6.
The etiology of the sign is unclear, with proposed theories including tumor infiltration, microinfarction, or effects from cytotocix edema 2. For reasons also unclear, all reported cases including the bloomy rind sign have been leptomeningeal metastases from lung adenocarcinoma, most commonly with EGFR mutations 1-6. However, the sign is considered rare, with one study finding the bloomy rind sign present in only 8% of patients in their series with leptomeningeal metastases 1.
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1. Mitsuya K, Nakasu Y, Deguchi S et al. FLAIR Hyperintensity Along the Brainstem Surface in Leptomeningeal Metastases: A Case Series and Literature Review. Cancer Imaging. 2020;20(1):84. doi:10.1186/s40644-020-00361-8 - Pubmed
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2. Liu X, Tan C, Zhu Y et al. Teaching NeuroImage: Bloomy Rind Sign of Leptomeningeal Carcinomatosis. Neurology. 2023;101(1):e99-e100. doi:10.1212/wnl.0000000000207124 - Pubmed
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3. Yokota H, Mukai H, Hattori S et al. Band-Like Hyperintensity Along the Ventral Surface of the Brain Stem on FLAIR and DWI in Leptomeningeal Carcinomatosis of Lung Adenocarcinoma. Radiology Case Reports. 2022;17(3):544-8. doi:10.1016/j.radcr.2021.11.054 - Pubmed
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4. Crombe A, Alberti N, Durieux M, Frulio N, Dousset V, Tourdias T. Exceptional Symmetric Anterior Brainstem Involvement in Leptomeningeal Carcinomatosis. Journal of Neuroradiology. 2014;41(4):279-81. doi:10.1016/j.neurad.2014.05.003 - Pubmed
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5. Brooks C, Bonura A, Beran R. T2-Hyperintense, Non-Gadolinium-Enhancing, Diffusion-Restricted Symmetrical Curvilinear Lesion of the Anterior Pons: A Rare Radiological Pattern of Leptomeningeal Metastatic Disease Secondary to Likely Lung Adenocarcinoma. BMJ Case Rep. 2021;14(1):e236265. doi:10.1136/bcr-2020-236265 - Pubmed
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6. Zoccarato M, Ferrati C, D'Errico I. Superficial Brainstem FLAIR Hyperintensity and Restricted Diffusion Leading to the Detection of Non–Small-Cell Lung Cancer. Neurology. 2023;101(2):88-9. doi:10.1212/wnl.0000000000207123 - Pubmed
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