Comparative spine imaging in leptomeningeal metastases
- 64 Downloads
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 wordsleptomeningeal metastasis spine MR CT myelography
Unable to display preview. Download preview PDF.
- 1.Chamberlain MC: Leptomeningeal metastasis: review of current concepts.Current Opinions in Oncology 4(3): 533–539, 1992Google Scholar
- 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
- 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
- 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.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
- 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