Imaging features of leptomeningeal metastases

• Published in: Clinical radiology Vol. 54; no. 11; pp. 765 - 771
• Main Authors: Collie, D.A., Brush, J.P., Lammie, G.A., Grant, R., Kunkler, I., Leonard, R., Gregor, A., Sellar, R.J.
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Ltd 01-11-1999; Elsevier
• Subjects: Adolescent; Adult; Aged; Arachnoid; Biological and medical sciences; Breast Neoplasms - cerebrospinal fluid; Female; Humans; Image Enhancement; leptomeningeal metastases; Magnetic Resonance Imaging; Male; Medical sciences; Meningeal Neoplasms - cerebrospinal fluid; Meningeal Neoplasms - diagnosis; Meningeal Neoplasms - secondary; Middle Aged; MRI; Neurology; Retrospective Studies; Tomography, X-Ray Computed; Tumors of the nervous system. Phacomatoses; MRI; leptomeningeal metastases; Human; Central nervous system disease; Radiologic investigation; Medical imagery; Leptomeninge; Clinical investigation; Computerized axial tomography; Malignant tumor; Metastasis; Nuclear magnetic resonance imaging
• ISSN: 0009-9260; 1365-229X
• DOI: 10.1016/S0009-9260(99)91181-9

AIMS: To assess the range of appearances, and accuracy of various methods of diagnosing leptomeningeal metastases.
MATERIALS AND METHODS: In a retrospective study, the notes and imaging of all patients with a radiological and/or CSF cytological diagnosis of leptomeningeal metastasis (LM) were identified, and assessed for the following: age and sex, primary tumour type, presenting symptoms, initial radiological and cytological diagnosis, radiological appearances and length of survival following diagnosis. Discordance between the CSF cytology and radiological diagnosis of LM was also noted.
RESULTS: 41 positive cases (36 female) of LM were identified over a 2.7 year period (diagnosis based on: imaging only - 19 cases, cytology only - 6, both - 16 cases). The average age was 48 years, and the most frequent primary tumour was breast carcinoma (
27
41
). Two thirds of patients presented with at least one cranial or spinal nerve palsy. Where performed, contrast-enhanced CT was normal in 40% (10/25), with LM mistaken for parenchymal disease in a further 24% (6/25). CSF cytology was positive in 85% (22/26). Gadolinium-enhanced MRI was positive in all cases where it was performed (
25
25
). Pial enhancement and nodularity was the commonest finding (67%), but other manifestations included nodular disease, neural enhancement and white matter changes. Prognosis was uniformly poor.
CONCLUSION: Leptomeningeal metastasic disease has a poor prognosis, and treatment regimen may differ from those of parenchymal CNS metastases. CT is normal or misleading in two thirds of patients, and CSF cytology may also be negative. Gadolinium-enhanced Tl-weighted MRI complements CSF cytology, and is the investigation of choice in patients with a non-haematological primary tumour and suspected LM.