Advanced MRI could help to differentiate meningeal carcinomatosis with mass effect from cerebral metastasis in prostate cancer

Prostatic neoplasms are the second cause of mortality due to cancer in men. Brain metastases are a rare presentation, whereas epidural localizations are relatively frequent. However both occur late in the evolution of the cancer. Thus a reliable, fast and non-invasive diagnosis would be useful in this setting. Regarding the prognosis of such disease, earlier treatment may probably influence the quality of life and postpone fatal evolution. However improved survival is more hypothetical. We report the case of a 69-year old man with a hormone refractory adenocarcinomatous prostatic cancer presenting with diffuse intracranial metastases. An MRI analysis using T2 perfusion images, diffusion weighted imaging (DWI) and apparent diffusion coefficient (ADC) maps excluded intra-axial brain metastases and concluded to the existence of voluminous nodular dural metastases. We discuss the imaging techniques and review literature of neurological complications of prostate cancer.