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Background
Leptomeningeal carcinomatosis (LC) involves the spread and seeding of malignant cells in the leptomeninges (arachnoid membrane and pia mater) and CSF. The prevalence of LC ranges from 5–15% of patients with solid and hematologic malignancies. Without therapy, median survival in patients with LC typically ranges from 4–6 weeks. As survival increases from advances in oncologic treatment and management, the incidence of LC is also expected to rise as patients present with more advanced stages of disease. This underscores the importance of recognizing LC and the impact the radiologist may have in contributing not only to surveillance and diagnosis of LC but also in paving way for expeditious management by the clinical team, including lumbar puncture and subsequent radiotherapy and/or intrathecal chemotherapy, for example. By extension, disease control can be optimized, neurologic function preserved, and life expectancy improved by as much as 2–6 months.

Educational Goals / Teaching Points
Learners will be able to define LC and become familiar with its pathophysiology, determine optimal imaging modalities and sequences for identifying/evaluating radiographic signs suggestive of LC, and avoid pitfalls in radiographic interpretation and diagnosis.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Hydrocephalus, pial enhancement, loculated enhancement, subependymal deposits, neural deposits, dural enhancement, white matter T2 signal, and parenchymal metastasis.

Conclusion
The risk of LC in oncologic patients persists as therapies and systemic management of cancers continue to improve survival. The development of LC significantly increases morbidity and mortality. By becoming familiar with the salient imaging characteristics of LC, the radiologist will be able to maintain an appropriately high index of suspicion for early diagnosis and subsequently guide the clinical team in facilitating expeditious care and in improving health outcomes.