Intracranial involvement in plasmacytomas and multiple myeloma: a pictorial essay.
BACKGROUND
The purpose of this pictorial essay is to increase awareness of the clinical presentation, neuroradiological findings, treatment options, and neuroradiological follow-up of plasmacytomas and multiple myeloma with intracranial growth.


METHODS
This pictorial essay reviews the clinical features and neuroradiological findings in seven patients (four women, three men; age range at diagnosis 62-82 years) followed in two institutions. Six patients, one with IgG-kappa plasmacytoma, and five with IgG-kappa (n = 3), IgG-lambda (n = 1), and nonsecretory (n = 1) multiple myeloma, had been seen over a period of 9 years in one institution, and the other patient with IgG-kappa plasmacytoma had been seen over a period of 3.5 years in the other.


RESULTS
Intracranial involvement is rare, most frequently resulting from osseous lesions in the cranial vault, skull base, nose, or paranasal sinuses. Primary dural or leptomeningeal involvement is rarer. Some typical findings of a dural and/or osseous plasmacytoma include iso- to hyperdensity on CT scan, T1 equal to high signal intensity and T2 markedly hypointense signal on MRI, and high vascularity possibly documented on intraarterial digital subtraction angiography. However, the neuroradiological findings generally lack specificity, since they are generally no different from those of meningioma, metastasis, lymphoma, dural sarcoma, plasma cell granuloma, infectious meningitis, and leptomeningeal carcinomatosis.


CONCLUSIONS
The spectrum of clinical and neuroradiological evaluation shows that intracranial involvement from plasmacytoma and multiple myeloma must be taken into account in the differential diagnosis of cranial osseous and meningeal disease.
Unit of Diagnostic and Therapeutic Neuroradiology, Policlinico Santa Maria alle Scotte, Azienda Ospedaliera Universitaria Senese, Viale Mario Bracci, 53100, Siena, Italy. alfonsocerase@interfree.it
Alfonso
A
Cerase
Annachiara
A
Tarantino
Alessandro
A
Gozzetti
Carmine Franco
CF
Muccio
Paola
P
Gennari
Lucia
L
Monti
Arturo
A
Di Blasi
Carlo
C
Venturi
D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000000981:diagnostic imaging* / Q000473:pathology*; D010954:Plasmacytoma / Q000000981:diagnostic imaging* / Q000473:pathology*; D014057:Tomography, X-Ray Computed