Prognostic value of O-(2-[18F]-fluoroethyl)-L-tyrosine PET in relapsing oligodendroglioma.

PURPOSE: To assess the relationship between F-18-fluoro-ethyl-tyrosine positron emission tomography (FET-PET) parameters of relapsing oligodendroglioma and progression-free survival. MATERIAL AND METHODS: The relationship of clinical parameters, FET-PET parameters (SUVmax, TBRmax, BTV, time-activity curves) and progression-free survival was analyzed using univariate and multivariate analysis in 42 adult patients with relapsing oligodendroglioma. Kaplan-Meier analysis was used to assess survival. RESULTS: Patients who did not undergo surgical resection of their relapsing tumor had significantly lower PFS if the tumor exhibited an SUVmax above 3.40 than those with an SUVmax below 3.40 (13.1 ± 2.3 months vs. 47.3 ± 6.0 months, respectively, p < .001). Patients who underwent surgery had similar PFS as the aforementioned non-operated patients with low SUVmax (53.6 ± 6.7 months, p = .948). The same was true for TBRmax using a threshold of 3.03 (PFS 12.5 ± 2.4 months vs. 44.0 ± 6.3 months / 53.6 ± 6.7 months, respectively; p < .001 / p = .825). Also, subjects with BTV below 10 cm3 that did not undergo surgery had a similar PFS as subjects who underwent surgery (40.2 ± 6.0 months vs. 52.4 ± 8.9 months, respectively, p = .587). Subjects with BTV above 10 cm3 and without surgery had a significantly worse PFS (13.8 ± 3.3 months, p < .001). Multivariate analysis showed that the prognostication by clinical parameters is improved by adding TBRmax to the model (AUC 0.945 (95% CI: 0.881-1.000), true classification rate 88.1%). CONCLUSION: FET-PET may provide added value for the prognostication of relapsing oligodendroglioma in addition to clinical parameters.

A novel infusion-drainage device to assess lower urinary tract function in neuro-imaging.

OBJECTIVE: To evaluate the applicability and precision of a novel infusion-drainage device (IDD) for standardized filling paradigms in neuro-urology and functional magnetic resonance imaging (fMRI) studies of lower urinary tract (LUT) function/dysfunction. SUBJECTS/PATIENTS AND METHODS: The IDD is based on electrohydrostatic actuation which was previously proven feasible in a prototype setup. The current design includes hydraulic cylinders and a motorized slider to provide force and motion. Methodological aspects have been assessed in a technical application laboratory as well as in healthy subjects (n=33) and patients with LUT dysfunction (n=3) undergoing fMRI during bladder stimulation. After catheterization, the bladder was pre-filled until a persistent desire to void was reported by each subject. The scan paradigm comprised automated, repetitive bladder filling and withdrawal of 100 mL body warm (37 °C) saline, interleaved with rest and sensation rating. Neuroimaging data were analysed using Statistical Parametric Mapping version 12 (SMP12). RESULTS: Volume delivery accuracy was between 99.1±1.2% and 99.9±0.2%, for different flow rates and volumes. Magnetic resonance (MR) compatibility was demonstrated by a small decrease in signal-to-noise ratio (SNR), i.e. 1.13% for anatomical and 0.54% for functional scans, and a decrease of 1.76% for time-variant SNR. Automated, repetitive bladder-filling elicited robust (P = 0.05, family-wise error corrected) brain activity in areas previously reported to be involved in supraspinal LUT control. There was a high synchronism between the LUT stimulation and the blood oxygenation level-dependent (BOLD) signal changes in such areas. CONCLUSION: We were able to develop an MR-compatible and MR-synchronized IDD to routinely stimulate the LUT during fMRI in a standardized manner. The device provides LUT stimulation at high system accuracy resulting in significant supraspinal BOLD signal changes in interoceptive and LUT control areas in synchronicity to the applied stimuli. The IDD is commercially available, portable and multi-configurable. Such a device may help to improve precision and standardization of LUT tasks in neuro-imaging studies on supraspinal LUT control, and may therefore facilitate multi-site studies and comparability between different LUT investigations in the future.

Natalizumab-Related Progressive Multifocal Leukoencephalopathy-Immune Reconstitution Inflammatory Syndrome: A Case Report Highlighting Clinical and MRI Features.

Multiple sclerosis (MS) patients treated with natalizumab often face the uncommon but severe complication of developing progressive multifocal leukoencephalopathy (PML). PML may be further complicated by immune reconstitution inflammatory syndrome (IRIS) after the removal of the drug. Since both PML and IRIS are associated with high morbidity and mortality rates, early clinical and radiological diagnosis of these complications is of paramount importance. Here, we report a case of an adult male patient who was diagnosed with PML after receiving natalizumab therapy for 6 years for the treatment of MS. Upon cessation of natalizumab, he presented with a paradoxical worsening of clinical and radiological findings consistent with an inflammatory brain injury due to IRIS. He was treated with high dose corticosteroid therapy followed by a gradual improvement in clinical and imaging findings. This article illustrates the magnetic resonance imaging (MRI) features of natalizumab-associated PML-IRIS, along with a brief overview of its clinical features, complications and management strategies.

Differential functional brain network connectivity during visceral interoception as revealed by independent component analysis of fMRI TIME-series.

Influential theories of brain-viscera interactions propose a central role for interoception in basic motivational and affective feeling states. Recent neuroimaging studies have underlined the insula, anterior cingulate, and ventral prefrontal cortices as the neural correlates of interoception. However, the relationships between these distributed brain regions remain unclear. In this study, we used spatial independent component analysis (ICA) and functional network connectivity (FNC) approaches to investigate time course correlations across the brain regions during visceral interoception. Functional magnetic resonance imaging (fMRI) was performed in thirteen healthy females who underwent viscerosensory stimulation of bladder as a representative internal organ at different prefill levels, i.e., no prefill, low prefill (100 ml saline), and high prefill (individually adapted to the sensations of persistent strong desire to void), and with different infusion temperatures, i.e., body warm (∼37°C) or ice cold (4-8°C) saline solution. During Increased distention pressure on the viscera, the insula, striatum, anterior cingulate, ventromedial prefrontal cortex, amygdalo-hippocampus, thalamus, brainstem, and cerebellar components showed increased activation. A second group of components encompassing the insula and anterior cingulate, dorsolateral prefrontal and posterior parietal cortices and temporal-parietal junction showed increased activity with innocuous temperature stimulation of bladder mucosa. Significant differences in the FNC were found between the insula and amygdalo-hippocampus, the insula and ventromedial prefrontal cortex, and the ventromedial prefrontal cortex and temporal-parietal junction as the distention pressure on the viscera increased. These results provide new insight into the supraspinal processing of visceral interoception originating from an internal organ.

Brainstem cavernoma surgery with the support of pre- and postoperative diffusion tensor imaging: initial experiences and clinical course of 23 patients.

The spatial complexity of highly vulnerable structures makes surgical resection of brainstem cavernomas (BSC) a challenging procedure. Diffusion tensor imaging (DTI) allows for the visualization of white matter tracts and enables a better understanding of the anatomical location of corticospinal and sensory tracts before and after surgery.We investigated the feasibility and clinical usefulness of DTI-based fiber tractography in patients with BSC.Pre- and postoperative DTI visualization of corticospinal and sensory tracts were retrospectively analyzed in 23 individuals with BSC. Preoperative and postoperative DTI-fiber accuracy were associated to the neurological findings. Preoperatively, the corticospinal tracts were visualized in 90 % of the cases and the sensory tracts were visualized in 74 % of the cases. Postoperatively, the corticospinal tracts were visualized in 97 % of the cases and the sensory tracts could be visualized in 80 % of the cases. In all cases, the BSC had caused displacement, thinning, or interruption of the fiber tracts to various degrees. Tract visualization was associated with pre- and postoperative neurological findings. Postoperative damage of the corticospinal tracts was observed in two patients. On follow-up, the Patzold Rating (PR) improved in 19 out of 23 patients (83 %, p = 0.0002).This study confirms that DTI tractography allows accurate and detailed white matter tract visualization in the brainstem, even when an intraaxial lesion affects this structure. Furthermore, visualizing the tracts adjacent to the lesion adds to our understanding of the distorted intrinsic brainstem anatomy and it may assists in planning the surgical approach in specific cases.

Non-water-suppressed proton MR spectroscopy improves spectral quality in the human spinal cord.

Magnetic resonance spectroscopy enables insight into the chemical composition of spinal cord tissue. However, spinal cord magnetic resonance spectroscopy has rarely been applied in clinical work due to technical challenges, including strong susceptibility changes in the region and the small cord diameter, which distort the lineshape and limit the attainable signal to noise ratio. Hence, extensive signal averaging is required, which increases the likelihood of static magnetic field changes caused by subject motion (respiration, swallowing), cord motion, and scanner-induced frequency drift. To avoid incoherent signal averaging, it would be ideal to perform frequency alignment of individual free induction decays before averaging. Unfortunately, this is not possible due to the low signal to noise ratio of the metabolite peaks. In this article, frequency alignment of individual free induction decays is demonstrated to improve spectral quality by using the high signal to noise ratio water peak from non-water-suppressed proton magnetic resonance spectroscopy via the metabolite cycling technique. Electrocardiography (ECG)-triggered point resolved spectroscopy (PRESS) localization was used for data acquisition with metabolite cycling or water suppression for comparison. A significant improvement in the signal to noise ratio and decrease of the Cramér Rao lower bounds of all metabolites is attained by using metabolite cycling together with frequency alignment, as compared to water-suppressed spectra, in 13 healthy volunteers.

Electrocardiogram-triggered, higher order, projection-based B0 shimming allows for fast and reproducible shim convergence in spinal cord ¹H MRS.

¹H MRS allows insight into the chemical composition of the central nervous system. However, as a result of technical challenges, it has rarely been applied to the spinal cord. In particular, the strong susceptibility changes around the spinal cord and the pulsatile flow of the cerebrospinal fluid lead to distinct B0 field distortions which often considerably degrade the spectral quality. Hence, B0 shimming is one of the main challenges in ¹H MRS of the spinal cord. Electrocardiogram (ECG)-triggered, higher order, projection-based B0 shimming was introduced and compared with both conventional projection-based B0 shimming and B0 shimming based on ECG-triggered, three-dimensional B0 field mapping. The linewidth of the unsuppressed water peak was used to evaluate the reproducibility and the potential improvement to B0 homogeneity. The use of ECG-triggered projection-based B0 shimming in combination with ECG triggering during preparation phases and triggering during acquisition of the spectra is the most robust method and thus helps to improve the spectral quality for MRS of the spinal cord.

Metal artefact reduction from dental hardware in carotid CT angiography using iterative reconstructions.

PURPOSE: To determine the value of a metal artefact reduction (MAR) algorithm with iterative reconstructions for dental hardware in carotid CT angiography. METHODS: Twenty-four patients (six of which were women; mean age 70 ± 12 years) with dental hardware undergoing carotid CT angiography were included. Datasets were reconstructed with filtered back projection (FBP) and using a MAR algorithm employing normalisation and an iterative frequency-split (IFS) approach. Three blinded, independent readers measured CT attenuation values and evaluated image quality and degrees of artefacts using axial images, multi-planar reformations (MPRs) and maximal intensity projections (MIP) of the carotid arteries. RESULTS: CT attenuation values of the internal carotid artery on images with metal artefacts were significantly higher in FBP (324 ± 104HU) datasets compared with those reconstructed with IFS (278 ± 114HU; P < 0.001) and with FBP on images without metal artefacts (293 ± 106HU; P = 0.006). Quality of IFS images was rated significantly higher on axial, MPR and MIP images (P < 0.05, each), and readers found significantly less artefacts impairing the diagnostic confidence of the internal carotid artery (P < 0.05, each). CONCLUSION: The MAR algorithm with the IFS approach allowed for a significant reduction of artefacts from dental hardware in carotid CT angiography, hereby increasing image quality and improving the accuracy of CT attenuation measurements. KEY POINTS: • CT angiography of the neck has proven value for evaluating carotid disease • Neck CT angiography images are often degraded by artefacts from dental implants • A metal artefact reduction algorithm with iterative reconstruction reduces artefacts significantly • Visualisation of the internal carotid artery is improved.

Differential representation of dynamic and static power grip force in the sensorimotor network.

Previous studies investigating the blood oxygen level-dependent (BOLD) signal in the human sensorimotor cortex during static force (maintained for a few seconds) and dynamic force (repetitive force pulses) resulted in contradictory findings. Therefore, we conducted a whole-brain functional magnetic resonance imaging study during a visuomotor task requiring the production of either dynamic or static power grip force. Thereby we aimed at clarifying whether the BOLD signal behaves differently with dynamic and static force in the primary motor cortex, and whether it behaves in the same way in all areas and regions involved in force production. In the static condition, participants applied visually guided, isometric grip force on a dynamometer of 20% maximal voluntary contraction (MVC) and held this force for 21 s. In the dynamic condition, self-paced force pulses of 20% MVC were produced at a rate of 0.5 Hz. Static and dynamic force production activated an overlapping network of sensorimotor cortical and subcortical regions. However, the production of a significantly higher mean static force compared with the dynamic force resulted in a significantly smaller BOLD signal in the contralateral motor cortex, confirming observations of an earlier investigation. In addition, we found that the ipsilateral anterior cerebellum behaved similar to the motor cortex, whereas in all other activated regions the activation during static and dynamic force did not significantly differ. These findings demonstrate that various regions of the sensorimotor network participate differentially in the production and control of low static and dynamic grip force, and raise important questions concerning the interpretation of the BOLD signal with respect to mechanisms of neurovascular coupling.

Differential force scaling of fine-graded power grip force in the sensorimotor network.

Force scaling in the sensorimotor network during generation and control of static or dynamic grip force has been the subject of many investigations in monkeys and human subjects. In human, the relationship between BOLD signal in cortical and subcortical regions and force still remains controversial. With respect to grip force, the modulation of the BOLD signal has been mostly studied for forces often reaching high levels while little attention has been given to the low range for which electrophysiological neuronal correlates have been demonstrated. We thus conducted a whole-brain fMRI study on the control of fine-graded force in the low range, using a power grip and three force conditions in a block design. Participants generated on a dynamometer visually guided repetitive force pulses (ca. 0.5 Hz), reaching target forces of 10%, 20%, and 30% of maximum voluntary contraction. Regions of interest analysis disclosed activation in the entire cortical and subcortical sensorimotor network and significant force-related modulation in several regions, including primary motor (M1) and somatosensory cortex, ventral premotor and inferior parietal areas, and cerebellum. The BOLD signal, however, increased monotonically with force only in contralateral M1 and ipsilateral anterior cerebellum. The remaining regions were activated with force in various nonlinear manners, suggesting that other factors such as visual input, attention, and muscle recruitment also modulate the BOLD signal in this visuomotor task. These findings demonstrate that various regions of the sensorimotor network participate differentially in the production and control of fine-graded grip forces.

Comparative velocity investigations in cerebral arteries and aneurysms: 3D phase-contrast MR angiography, laser Doppler velocimetry and computational fluid dynamics.

In western populations, cerebral aneurysms develop in approximately 4% of humans and they involve the risk of rupture. Blood flow patterns are of interest for understanding the pathogenesis of the lesions and may eventually contribute to deciding on the most efficient treatment procedure for a specific patient. Velocity mapping with phase-contrast magnetic resonance angiography (PC-MRA) is a non-invasive method for performing in vivo measurements on blood velocity. Several hemodynamic properties can either be derived directly from these measurements or a flow field with all its parameters can be simulated on the basis of the measurements. For both approaches, the accuracy of the PC-MRA data and subsequent modeling must be validated. Therefore, a realistic transient flow field in a well-defined patient-specific silicone phantom was investigated. Velocity investigations with PC-MRA in a 3 Tesla MR scanner, laser Doppler velocimetry (LDV) and computational fluid dynamics (CFD) were performed in the same model under equal flow conditions and compared to each other. The results showed that PC-MRA was qualitatively similar to LDV and CFD, but showed notable quantitative differences, while LDV and CFD agreed well. The accuracy of velocity quantification by PC-MRA was best in straight artery regions with the measurement plane being perpendicular to the primary flow direction. The accuracy decreased in regions with disturbed flow and in cases where the measurement plane was not perpendicular to the primary flow. Due to these findings, it is appropriate to use PC-MRA as the inlet and outlet conditions for numerical simulations to calculate velocities and shear stresses in disturbed regions like aneurysms, rather than derive these values directly from the full PC-MRA measured velocity field.

Recurrent unilateral peripheral facial palsy in a patient with an enlarged styloid process.

BACKGROUND: Recurrent peripheral facial paresis is a rare symptom that may be caused by multiple pathologic conditions. METHODS: We report a case of recurrent peripheral facial palsies caused by an ipsilateral enlarged styloid process. A surgical excision of the process was performed. RESULTS: The treatment was well tolerated. Postoperatively, no further recurrent paresis was observed. CONCLUSION: To the best of our knowledge, this is the first case study of an enlarged styloid process with facial paresis. A detailed workup, including imaging, should be performed in cases with recurrent facial paresis and/or cases with a history of trauma and facial paresis and, of course, to exclude a neoplastic etiology.

Sensorimotor tongue representation in individuals with unilateral upper limb amelia.

The purpose of the present study was to examine the impact of the congenital absence of one hand on cortical organization of the sensorimotor cortex (S1/M1). We investigated the tongue representation in S1/M1 in nine participants with normally developed limbs, comprising the control group, and in eight persons with a congenitally completely missing hand (i.e. unilateral hand amelia). All participants were examined by fMRI while performing horizontal tongue movements. The significantly activated clusters covering S1/M1 in both hemispheres were analyzed with respect to the number and intensity of activated voxels, as well as the location of the activation. In the right-handed control group, the number of activated voxels was significantly higher in the left as compared to the right hemisphere demonstrating a clear left hemispheric motor dominance for horizontal tongue movements. In the amelic individuals, no such hemispheric lateralization effect was observed. The neural activation pattern underlying tongue movement, however, was enlarged and displaced in the hemisphere contralateral to the missing limb when compared to the respective motor non-dominant, right hemisphere of the control group participants. The present findings suggest that congenital absence of one hand leads to an appreciably altered topological organization of S1/M1 consisting of an enlargement of the tongue representation and a shift towards the "hand" area which, however, had never received any input from a hand.

Value of 18F-FET PET in Patients With Suspected Tumefactive Demyelinating Disease-Preliminary Experience From a Retrospective Analysis.

PURPOSE: To investigate the diagnostic value of F-fluoroethyl-L-tyrosine (FET) positron emission tomography (PET) in patients with suspected tumefactive demyelinating disease. METHODS: We retrospectively examined FET-PET and MR imaging of 21 patients (12 female, 9 male) with known demyelinating disease and newly diagnosed tumefactive lesions. The maximum standardized uptake value (SUVmax), time activity curves (TAC) and lesion-to-background ratio (TBR) of these lesions were calculated. The standard of reference consisted of biopsy and/or follow-up imaging. FET parameters of true neoplastic lesions and tumefactive demyelinating lesions were compared using Mann-Whitney U-test and receiver operating characteristic (ROC) analysis. RESULTS: Nine patients (42.9%) had neoplastic lesions, 12 patients (57.1%) had tumefactive demyelinating lesions. TBRmax, SUVmax and TAC were significantly different between demyelinating lesions and neoplastic lesions: Tumors had a higher TBRmax (3.53 ± 1.09 vs. 1.48 ± 0.31, respectively; P < 0.001) and SUVmax (3.95 ± 1.59 vs. 1.86 ± 0.50, respectively; P < 0.001) than tumefactive demyelinating lesions. The TAC of tumors was significantly higher compared to tumefactive demyelinating lesions at all time points (P < 0.05). ROC analysis revealed that a TBRmax threshold of 2.2 and a SUVmax threshold of 2.5 could reliably differentiate tumor and tumefactive demyelination (area under the curve, 1.000 and 0.958, respectively). CONCLUSION: In patients with demyelinating disease, FET-PET parameters TBRmax (cut-off 2.2) and SUVmax (cut-off 2.5) are able to distinguish tumefactive demyelinations from true neoplastic lesions.

Value of 18F-FET PET in adult brainstem glioma.

PURPOSE: To investigate 18F-fluoro-ethyl-tyrosine positron emission tomography (FET-PET) imaging characteristics of adult brainstem glioma (BSG). MATERIALS AND METHODS: FET-PET imaging and progression-free survival (PFS) of 16 adult patients with BSG was analyzed (9 high-grade gliomas, 7 low-grade gliomas). SUVmax, TBR, and time activity curves of FET-PET were calculated. RESULTS: Progressive gliomas had higher SUVmax (3.57 ±â€¯1.47 vs. 1.60 ±â€¯0.51; p = 0.003) and TBRmax (3.00 ±â€¯1.12 vs. 1.36 ±â€¯0.33; p = 0.001) than stable gliomas. Kaplan-Meier analysis showed longer PFS of tumors with TBRmax < 2.0 compared to tumors with TBRmax > 2.0 (665 ±â€¯32 days versus 220 ±â€¯39 days; p < 0.001). CONCLUSION: FET-PET uptake might be associated with disease progression in adult BSG.

Local resectability assessment of head and neck cancer: Positron emission tomography/MRI versus positron emission tomography/CT.

BACKGROUND: The purpose of this study was to compare the diagnostic accuracy of positron emission tomography (PET)/MRI with PET/CT for local resectability of head and neck cancer. METHODS: Sequential contrast-enhanced PET/CT-MRI was performed in 58 patients referred for the staging or restaging of head and neck cancer. Tumors were assessed with PET/CT and PET/MRI for the presence of resectability-defining factors: T4b status (mediastinal invasion, invasion of the prevertebral space, and vascular encasement), and another 8 findings that would imply obstacles for surgical cure (invasion of the laryngeal cartilage, invasion of the preepiglottic fat pad, perineural spread, orbital invasion, bone infiltration, skull base invasion, dural infiltration, and invasion of the brachial plexus). RESULTS: The sensitivity/specificity/accuracy of local resectability-defining factors of PET/CT and PET/MRI was 0.92/0.99/0.98 and 0.98/0.99/0.99 (P = .727), respectively, per lesion, and 0.96/0.87/0.91 and 0.96/0.90/0.93 (P = .687), respectively, per patient. CONCLUSION: Both contrast-enhanced PET/MRI and contrast-enhanced PET/CT can serve as reliable examinations for defining local resectability of head and neck cancer.

PET+MR versus PET/CT in the initial staging of head and neck cancer, using a trimodality PET/CT+MR system.

PURPOSE: To compare the diagnostic accuracy of PET+MR with PET/CT in the initial staging of head and neck cancer. MATERIALS AND METHODS: Contrast-enhanced PET/CT+MR was performed in 27 patients with newly diagnosed head and neck cancer. PET/CT and PET+MR were evaluated separately, and the TNM stage and factors influencing treatment were assessed. RESULTS: The TNM staging by PET+MR was comparable to PET/CT (T: p=0.331, N: p=0.453, M: p=0.034). The sensitivity/specificity/accuracy of treatment-influencing factors by PET/CT and PET+MR were 0.68/0.99/0.97, and 1.00/1.00/0.99, respectively. CONCLUSIONS: Whole-body staging with PET+MR yields at least equal diagnostic accuracy as PET/CT in head and neck cancer.

A portable and low-cost fMRI compatible pneumatic system for the investigation of the somatosensensory system in clinical and research environments.

There still is a need for devices that allow reproducible stimulation of skin areas of the human body. We constructed a stimulation system and tested it by using brief pneumatic stimulation to the right thumb of nine healthy volunteers. BOLD-signals in response to tactile stimulation with frequencies of 1, 3 and 5 Hz were measured using a 3T MRI scanner. The stimulation device consists of synthetic membranes connected to plastic tubes capable of carrying compressed air, and an electronic component, which controls the on- and off-switching of an electromagnetic valve. The valve near the MR-scanner did not lower the image quality. Primary somatosensory activation contralateral to the stimulation site was reliably detected in response to a stimulus magnitude of 3.5 bar in all volunteers. 1 Hz stimulation resulted in higher maximal percentage BOLD-signal changes. Our device is an easy-to-construct, low-cost and portable tool suitable for research and clinical environments. It permits passive non-painful stimulation relevant for clinical assessments and is also compatible with magnetoencephalography (MEG) and electroencephalography (EEG). In basic and clinical research, this device therefore contributes to meaningful comparisons between results obtained with different techniques.

Suprasellar pilocytic astrocytoma in an adult with hemorrhage and leptomeningeal dissemination: case report and review of literature.

Pilocytic astrocytoma (PA) is a low-grade tumor. It has an excellent prognosis after total resection. Leptomeningeal dissemination and hemorrhage are very rare to be associated with PA and lead to unfavorable prognosis. A 35-year-old man was diagnosed with a hemorrhagic suprasellar PA in 2006. Subsequent examination in 2007 revealed another large subdural hemorrhagic lesion in the sacral region, which proved to be PA by histopathologic assessment. Other leptomeningeal foci were discovered mainly at the craniocervical junction. The patient underwent subtotal resection and received chemotherapy with disease control for 7 years. Progression of the disseminated disease has recently occurred; however, the patient is still alive with stable disease after radiotherapy. The radiological features, management, and relevant literature are also presented. Our report heightens the awareness of PA in the adult population and the importance of close surveillance for the leptomeningeal spread, especially for sellar region tumors.