Journal of Neuro-Oncology

, Volume 23, Issue 3, pp 233–238 | Cite as

Comparative spine imaging in leptomeningeal metastases

  • Marc C. Chamberlain
Clinical Study


Sixty-one patients (34 men; 27 women) ranging in age from 1–74, median 40 years with leptomeningeal metastases (LM) as defined by either positive CSF cytology (85%) or a clinical syndrome and compatible neuroradiographic findings (15%) underwent CT-myelographic (CT-M), spine MR (S-MR) and111Indium-DTPA CSF flow studies (FS). Each patient underwent sequential spine imaging (CT-M, S-MR and FS) over a median of 5 days. In 57% of patients, all 3 spine imaging modalities were normal. 43% of patients demonstrated abnormalities on spine imaging; 33% had abnormal FS, 34% showed abnormalities on S-MR and 33% had abnormalities by CT-M. FS were most sensitive for detecting interruption of CSF flow whereas CT-M and S-MR better demonstrated nerve root thickening (CT-M ∼ S-MR), cord enlargement (CT-M > S-MR), subarachnoid nodules (S-MR>CT-M), intraparenchymal cord tumor (S-MR > CT-M) and epidural spinal cord compression (S-MR=CT-M). In conclusion, patients with LM frequently require spine imaging and the results of this study suggest both S-MR and FS provide the best radiographic assessment wherein S-MR is superior for detecting bulky disease and FS best demonstrates interruption of CSF flow.

Key words

leptomeningeal metastasis spine MR CT myelography 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Chamberlain MC: Leptomeningeal metastasis: review of current concepts.Current Opinions in Oncology 4(3): 533–539, 1992Google Scholar
  2. 2.
    Wasserstrom WR, Glass JP, Posner JB: Diagnosis and treat-ment of leptomeningeal metastases from solid tumors: Experience will 90 patients. Cancer 49: 759–772, 1982Google Scholar
  3. 3.
    Little JR, Dale AJD, Okazakli: Meningeal carcinomatosis: Clinical manifestations. Arch Neurol 30: 138–143, 1974PubMedGoogle Scholar
  4. 4.
    Olson ME, Chernik NL, Posner JB: Infiltration of the leptomeninges by systemic cancer. A clinical and pathologic study. Arch Neurol 30: 122–137, 1974PubMedGoogle Scholar
  5. 5.
    Chamberlain MC, Corey-Bloom J: Leptomeningeal metastases:111Indium-DTPA CSF flow studies. Neurology 41: 1765–1769, 1991PubMedGoogle Scholar
  6. 6.
    Pedersen AG, Paulson OB, Gyldensted C: Metrizamide myelography in patients with small cell carcinoma of the lung suspected of meningeal carcinomatosis. J Neuro Onc 3: 85–89, 1985Google Scholar
  7. 7.
    Kramer ED, Rafto S, Packer RJ, Zimmerman RA: Comparison of myelography with CT follow-up versus gadolinium MRI for subarachnoid metastatic disease in children. Neurology 41: 46–50, 1991PubMedGoogle Scholar
  8. 8.
    Sze G, Abramson A, Krol G, Liu D, Amster J, Zimmerman RD, Deck MDF: Gadolinium-DTPA in the evaluation of intradural extramedullary spinal disease. AJR 9: 153–163, 1988Google Scholar
  9. 9.
    Krol G, Sze G, Malkin M, Walker R: MR or cranial and spinal meningeal carcinomatosis: Comparison with CT and myelography. AJR 9: 709–714, 1988Google Scholar
  10. 10.
    Kim KS, Ho SU, Weinberg PE, Lee C: Spinal leptomeningeal infiltration by systemic cancer. Myelographic features. AJR 139: 361–365, 1982PubMedGoogle Scholar
  11. 11.
    Wiener MD, Boyko OB, Friedman HS, Hockenberger B, Oakes WJ: False-positive spinal MR findings for subarachnoid spread of primary CNS tumor in postoperative pediatric patients. AJNR 11: 1100–1103, 1990PubMedGoogle Scholar
  12. 12.
    Rippe DF, Boyko OB, Friedman HSet al.: Gd—DTPA-enhanced MR imaging of leptomeningeal spread of primary CNS tumor in children. AJNR 11: 329–332, 1990PubMedGoogle Scholar
  13. 13.
    Lim V, Sobel DF, Zyroff J: Spinal cord pial metastases: MR imaging with gadopentetate dimeglumine. AJNR 11: 975–982, 1990PubMedGoogle Scholar
  14. 14.
    Glass JP, Melamed M, Chernik NL, Posner JB: Malignant cells in cerebrospinal fluid (CSF): The meaning of a positive CSF cytology. Neurology 28: 1369–1375, 1979Google Scholar
  15. 15.
    Enzmann DR, Pelc NJ: Brain motion: measurement with phase-contrast MR imaging. Radiology 185: 653–660, 1992PubMedGoogle Scholar
  16. 16.
    Feinberg DA: Modern concepts of brain motion and cerebrospinal fluid flow. Radiology 185: 630–632, 1992PubMedGoogle Scholar
  17. 17.
    Schellinger D, LeBihan D, Sunder SR, Cammarata CA, Patronas NJ, Deveikis JP, Levy LM: Mr of slow CSF flow in the spine. AJNR 13: 1393–1403, 1992PubMedGoogle Scholar

Copyright information

© Kluwer Academic Publishers 1995

Authors and Affiliations

  • Marc C. Chamberlain
    • 1
  1. 1.Department of NeurosciencesUniversity of CaliforniaSan DiegoUSA

Personalised recommendations