Differentiating leptomeningeal diseases through enhancement patterns: A pictorial essay

Leptomeningeal diseases represent a diverse group of pathological conditions affecting the pia and arachnoid mater, encompassing a wide spectrum of infective-inflammatory, neoplastic, and vascular etiologies. Early and accurate diagnosis is crucial due to the often severe clinical implications and overlapping imaging features. This review provides a comprehensive overview of commonly encountered and some rare leptomeningeal diseases, emphasizing their pathophysiology, clinical manifestations, and distinctive imaging characteristics. We categorize these conditions based on their underlying etiology and highlight key differentiating features to facilitate accurate radiological interpretation. By integrating imaging findings with clinical background, this review aims to support neuroradiologists and clinicians in the effective evaluation and differential diagnosis of leptomeningeal diseases. Enhanced understanding of these pathologies will aid earlier diagnosis and optimal management, ultimately leading to better patient outcomes.