Choroid plexus asymmetry on routine MRI as an imaging signature of breast cancer brain metastasis
- 1Department of Radiology, Shantou Central Hospital, Shantou 515031, China; Clinical Research Center, Shantou Central Hospital, Shantou 515031, China
Abstract
BackgroundBrain metastasis affects 15-30% of patients with breast cancer, yet brain-specific biology underlying central nervous system colonisation is poorly captured by available clinical measures. The choroid plexus, an MRI biomarker of neuroinflammation and a primary immune-cell gateway implicated in brain metastasis, has not been examined in this setting.
MethodsIn a real-world, cross-sectional study of 1,000 women with breast cancer (190 with brain metastasis), bilateral choroid plexus volumes on contrast-enhanced brain MRI were quantified using a deep-learning pipeline. Guided by the principle that hemispheric asymmetry indices are sensitive to focal pathology, this study derived from an exploratory bilateral volume comparison a parameter-free Choroid Plexus Asymmetry Index (CPAI = |L-R|/(L+R)). Multivariable logistic regression, propensity-score matching, laterality and grade-stratified analyses assessed robustness.
ResultsThe results show that total choroid plexus volume does not differ between groups, whereas left and right volumes change asymmetrically and CPAI is elevated in patients with metastasis (median 0.088 vs 0.059; Cliffs {delta} = 0.20, 95% CI 0.10-0.29). CPAI is minimally correlated with 10 peripheral markers and with histological grade. The association is robust under multivariable adjustment (adjusted OR 1.58 per +1 SD, 95% CI 1.32-1.88) and propensity-score matching, with |CPAI| scaling with metastatic burden, independent of metastasis side.
ConclusionsChoroid plexus morphological asymmetry on routine brain MRI is associated with breast cancer brain metastasis independently of peripheral inflammation, tumour grade and conventional markers.
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BibTeX
@misc{lin2026choroid,
title = {{Choroid plexus asymmetry on routine MRI as an imaging signature of breast cancer brain metastasis}},
author = {D. Lin and T. Zhu and X. Ma and Y. Hu and Y. Hao and Z. Cai and S. Chen and D. Wang and M. Li and X. Chen and J. Li and Y. Lin and H. Huang and Z. Yang and G. Xiao and Z. Dai},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.13.26365386},
url = {https://www.medrxiv.org/content/10.64898/2026.10.13.26365386v1},
note = {CC BY-NC},
}
RIS
TY - UNPB
TI - Choroid plexus asymmetry on routine MRI as an imaging signature of breast cancer brain metastasis
AU - D. Lin
AU - T. Zhu
AU - X. Ma
AU - Y. Hu
AU - Y. Hao
AU - Z. Cai
AU - S. Chen
AU - D. Wang
AU - M. Li
AU - X. Chen
AU - J. Li
AU - Y. Lin
AU - H. Huang
AU - Z. Yang
AU - G. Xiao
AU - Z. Dai
PY - 2026
DA - 2026/10/13
PB - medRxiv
DO - 10.64898/2026.10.13.26365386
UR - https://www.medrxiv.org/content/10.64898/2026.10.13.26365386v1
AB - BackgroundBrain metastasis affects 15-30% of patients with breast cancer, yet brain-specific biology underlying central nervous system colonisation is poorly captured by available clinical measures. The choroid plexus, an MRI biomarker of neuroinflammation and a primary immune-cell gateway implicated in brain metastasis, has not been examined in this setting. MethodsIn a real-world, cross-sectional study of 1,000 women with breast cancer (190 with brain metastasis), bilateral choroid plexus volumes on contrast-enhanced brain MRI were quantified using a deep-learning pipeline. Guided by the principle that hemispheric asymmetry indices are sensitive to focal pathology, this study derived from an exploratory bilateral volume comparison a parameter-free Choroid Plexus Asymmetry Index (CPAI = |L-R|/(L+R)). Multivariable logistic regression, propensity-score matching, laterality and grade-stratified analyses assessed robustness. ResultsThe results show that total choroid plexus volume does not differ between groups, whereas left and right volumes change asymmetrically and CPAI is elevated in patients with metastasis (median 0.088 vs 0.059; Cliffs {delta} = 0.20, 95% CI 0.10-0.29). CPAI is minimally correlated with 10 peripheral markers and with histological grade. The association is robust under multivariable adjustment (adjusted OR 1.58 per +1 SD, 95% CI 1.32-1.88) and propensity-score matching, with |CPAI| scaling with metastatic burden, independent of metastasis side. ConclusionsChoroid plexus morphological asymmetry on routine brain MRI is associated with breast cancer brain metastasis independently of peripheral inflammation, tumour grade and conventional markers.
ER -