The diagnostic accuracy of magnetic resonance imaging and cerebrospinal fluid cytology in leptomeningeal metastasis

• Published in: Journal of neurology Vol. 246; no. 9; pp. 810 - 814
• Main Authors: STRAATHOF, C. S. M, DE BRUIN, H. G, DIPPEL, D. W. J, VECHT, C. J
• Format: Journal Article
• Language: English
• Published: Berlin Springer 01-09-1999
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Cerebrospinal Fluid - cytology; Cohort Studies; Female; Gadolinium; Humans; Magnetic Resonance Imaging; Male; Medical sciences; Meningeal Neoplasms - cerebrospinal fluid; Meningeal Neoplasms - diagnosis; Meningeal Neoplasms - secondary; Middle Aged; Neurology; Tumors of the nervous system. Phacomatoses; Performance evaluation; Human; Nervous system diseases; Central nervous system disease; Cytology; Medical imagery; Leptomeninge; Malignant tumor; Diagnosis; Cerebrospinal fluid; Metastasis; Nuclear magnetic resonance imaging
• ISSN: 0340-5354; 1432-1459
• DOI: 10.1007/s004150050459

Diagnostic decision making in the case of patients suspected of having leptomeningeal metastasis (LM) can be very difficult. The results of cerebrospinal fluid (CSF) cytology can be repeatedly negative, and the predictive value of gadolinium-enhanced magnetic resonance imaging (MRI) is not well known. We report the results of CSF cytology and Gd MRI in 61 patients with known cancer, suspected of having LM. We combined our data with those from a similar study and calculated the sensitivity and specificity of CSF and Gd MRI, in the absence of a "gold standard diagnosis." CSF cytology was positive for LM in 35 patients and MRI in 38. With CSF cytology sensitivity 75% and specificity 100%, with Gd MRI sensitivity was 76% but specificity only 77%. We conclude that Gd MRI provides strong support in the diagnosis of LM in patients with cancer who have negative results on CSF cytology.