Journal of Neuro-Oncology

, Volume 38, Issue 2–3, pp 135–140 | Cite as

Radioisotope CSF flow studies in leptomeningeal metastases

  • Marc C. Chamberlain

Abstract

Background: Leptomeningeal metastases is a frequent neuro-oncologic complication in patients with cancer. Objective: Radionuclide CSF flow studies provide a unique method of evaluating CSF compartments in patients with leptomeningeal metastases. Methods: Radionuclide CSF flow studies are performed by injecting 111Indium-DTPA into either the ventricular or lumbar CSF compartment. 111Indium-DTPA is entrained by CSF and flows through CSF compartments based on normal CSF physiology. Results: Normal times to appearance of 111Indium-DTPA following intraventricular injection in either adults or children are as follows: ventricles (median 1 minute); cisterna magna/basal cisterns (5); cervical (15); thoracic (20); and lumbar (30) spinal subarachnoid spaces; and sylvian cisterns (50). Normal times to appearance of 111Indium-DTPA following intralumbar injection are as follows: lumbar (1); thoracic (22.5); cervical (32.5) spinal subarachnoid spaces; cisterna magna/basal cisterns (37.5); sylvian cisterns (65); ventricles (1,440); and cerebral convexities (1,440). In 30 consecutive patients, 47% of patients had documented compartmentalization of CSF by 111Indium-DTPA CSF flow studies. 13% had base of brain obstruction of whom 50% responded with re-establishment of normal CSF flow and 33% had spinal subarachnoid space block of whom 40% following therapy had re-establishment of normal CSF flow. In 61 consecutive patients, 33% of patients had abnormal spinal CSF flow studies which better demonstrated interruption of CSF flow when compared to CT myelography and spine MR. In 40 patients, all with CSF block, 20 of whom responded to therapy with re-establishment of normal CSF flow as compared to 20 with refractory CSF block, significant differences were seen in median survival and cause of death favoring patients with normal or restored CSF flow. Conclusions: Radioisotope CSF flow studies in patients with leptomeningeal metastasis appear to have two practical uses. First, radioisotope CSF flow studies by documenting normal CSF flow predict for homogenous distribution of intra-CSF chemotherapy. Secondly, in patients with CSF flow obstruction refractory to site of obstruction therapy, limited survival, rapid leptomeningeal disease progression and death due to progressive CNS disease is predicted.

CSF flow studies leptomeningeal mestastases 

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References

  1. 1.
    Larson SM, Johnson GS, Ommaya AK, Jones AE, Di Chiro G: The radionuclide ventriculogram. JAMA 224: 853–857, 1973Google Scholar
  2. 2.
    Di Chiro G, Hammock MK, Bleyer WA: Spinal descent of cerebrospinal fluid in man. Neurol 25: 1–8, 1976Google Scholar
  3. 3.
    Lyons MK, Meyer FB: Cerebrospinal fluid physiology and the management of increased intracranial pressure. Mayo Clin Proc 75: 684–707, 1990Google Scholar
  4. 4.
    Chamberlain MC, Corey-Bloom J: Leptomeningeal metastasis: Indium-DTPA CSF flow studies. Neurol 41: 1765–1769, 1991Google Scholar
  5. 5.
    Chamberlain MC: Pediatric leptomeningeal metastasis: 111Indium-DTPA CSF flow studies. J Child Neurol 9: 150–154, 1994Google Scholar
  6. 6.
    Haaxma-Reiche H, Piers DA, Beekhuis H: Normal cerebrospinal fluid dynamics: A study with intraventricular injection of 111In-DTPA in leukemia and lymphoma without meningeal involvement. Arch Neurol 46: 997–999, 1989Google Scholar
  7. 7.
    Grossman SA, Trump CL, Chen DCP, Thompson G, Camargo E: Cerebrospinal fluid flow abnormalities in patients with neoplastic meningitis. Am J Med 73: 641–647, 1982Google Scholar
  8. 8.
    Chamberlain MC: Comparative spine imaging in leptomeningeal metastases. J Neuro Oncol 23: 233–238, 1995Google Scholar
  9. 9.
    Chamberlain MC: Spinal 111Indium-DTPA CSF flow studies in leptomeningeal metastasis. J Neuro Oncol 25: 135–141, 1995Google Scholar
  10. 10.
    Chamberlain MC, Kormanik P: Prognostic significance of 111Indium-DTPA CSF flow studies. Neurol 46(6): 1674–1677, 1996Google Scholar
  11. 11.
    Chamberlain MC: Current concepts in leptomeningeal metastasis. Curr Opin Oncol 4(3): 533–539, 1992Google Scholar
  12. 12.
    Chamberlain MC: New approaches to and current treatments of leptomeningeal metastases. Curr Opin Neurol 7: 492–500, 1994Google Scholar
  13. 13.
    Glantz M, Hall WA, Cole BF et al.: Diagnosis, management, and survival of patients with leptomeningeal cancer based on cerebrospinal fluid-flow studies. Cancer 75: 2919–2931, 1995Google Scholar

Copyright information

© Kluwer Academic Publishers 1998

Authors and Affiliations

  • Marc C. Chamberlain
    • 1
  1. 1.Kaiser-PermanenteCaliforniaUSA

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