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Meningeal enhancement depicted by magnetic resonance imaging in tumor patients: neoplastic meningitis or therapy-related enhancement?

  • Diagnostic Neuroradiology
  • Published:
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Abstract

Purpose

To assess the prevalence of false-positive meningeal contrast enhancement in patients with solid tumors who were undergoing chemotherapy.

Methods

A total of 2572 magnetic resonance imaging (MRI) examinations of the brain were retrospectively evaluated by two readers for the presence of pathological meningeal contrast enhancement conspicuous for neoplastic meningitis. These patients either had malignant melanoma, breast or lung cancer, or lymphoma. The reference standards were cerebrospinal fluid cytology results and follow-up MRI. In cases with pathological contrast enhancement that decreased upon follow-up and non-malignant cytology, the enhancement pattern was further described as pial or dural, local or diffuse, or supra- or infra-tentorial. Moreover, the underlying therapy regimes were assessed.

Results

The final study cohort included 78 patients (51 females, median age 57 years), of which 11 patients (14.1%) had a repeated non-malignant cytology (‘pseudomeningeosis’). In one case, this finding, a granular pleocytosis, was attributed to previous radiotherapy. Of the remaining patients, seven were receiving multimodal, immunotherapy-based therapy regimens. Patients with unsuspicious cytology had a predominantly supratentorial distribution pattern in comparison to patients with neoplastic meningitis.

Conclusions

The overall prevalence of the presence of false-positive meningeal contrast enhancement is low (< 1%) and not associated with specific imaging patterns. We hypothesize that there is a possible relationship between immunotherapy and ‘pseudomeningeosis’. Therefore, in all cases with suspected neoplastic meningitis, the cerebrospinal fluid should be analyzed to confirm the diagnosis, especially in patients undergoing immunotherapy.

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Funding

No funding was received for this study.

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Authors and Affiliations

  1. Institute of Clinical Radiology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany

    Georg Bier

  2. Diagnostic and Interventional Neuroradiology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany

    Georg Bier, Ulrike Ernemann & Johann-Martin Hempel

  3. Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany

    Bernhard Klumpp & Heike Preibsch

  4. Department of Radiology, Rems-Murr-Hospital, Am Jakobsweg 1, 71364, Winnenden, Germany

    Bernhard Klumpp

  5. Department of Neurosurgery and Interdisciplinary Division of Neurooncology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany

    Constantin Roder

  6. Department of Dermatology, Eberhard Karls University Tuebingen, Liebermeisterstr. 25, 72076, Tuebingen, Germany

    Claus Garbe

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  1. Georg Bier
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Correspondence to Georg Bier.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standard. For this type of study formal consent is not required.

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Bier, G., Klumpp, B., Roder, C. et al. Meningeal enhancement depicted by magnetic resonance imaging in tumor patients: neoplastic meningitis or therapy-related enhancement?. Neuroradiology 61, 775–782 (2019). https://doi.org/10.1007/s00234-019-02215-y

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  • DOI: https://doi.org/10.1007/s00234-019-02215-y

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