Abstract
Leptomeningeal metastases (LM) is often an elusive disease frequently diagnosed at an advanced clinical stage. Early diagnosis may allow for prompt initiation of treatment with minimal tumor burden and maximal chance of survival, especially in solid tumors such as breast cancer. Although the method of choice for imaging LM currently is by gadolinium enhanced magnetic resonance imaging (MRI), the technique has a high sensitivity but low specificity. We report the first case of Carbon 11-labelled methionine (Cmet) positron emission tomography (PET) imaging of leptomeningeal metastases in a patient with primary breast cancer. This patient presented with clinical features suggestive of LM, but had inconclusive cerebrospinal fluid (CSF) findings. Although, the contrast enhanced MRI revealed calvarial and meningeal lesions, it is known that meningeal enhancement on MRI does not always indicate metastases. In this clinical dilemma the strong methionine uptake on PET helped steer the diagnosis in favor of cancerous infiltration even before the CSF cytology became positive for malignancy.
Similar content being viewed by others
References
Chamberlain MC: Leptomeningeal metastases: a review of evaluation and treatment. J Neuro-Oncol 37: 271–284, 1998
De Angelis LM: Current diagnosis and treatment of leptomeningeal metastasis. J Neuro-Oncol 38: 245–252, 1998
Straathof CSM, de Bruin HG, Dippel DWJ, Vecht CJ: The diagnostic accuracy of magnetic resonance imaging and cerebrospinal fluid cytology in leptomeningeal metastasis. J Neurol 246: 810–814, 1999
Schumacher M, Orszagh M: Imaging techniques in neoplastic meningiosis. J Neuro-Oncol 38: 111–120, 1998
Chamberlain M, Sandy A, Press G: Leptomeningeal metastases. A comparison of gadolinium-enhanced MR and contrast-enhanced CT of the brain. Neurology 40: 435–438, 1990
Wolfgang G, Marcus D, Ulrike S: LC: clinical syndrome in different primates. J Neuro-Oncol 38: 103–110, 1998
Wasserstrom W, Glass J, Posner J: Diagnosis and treatment of leptomeningeal metastases from solid tumors experience with 90 patients. Cancer 49: 759–772, 1982
Glass J, Melamed M, Chernik N, Posner J: Malignant cells in cerebrospinal fluid (CSF). The meaning of a positive CSF cytology. Neurology 29: 1369–1375, 1979
Sze G, Soltsky S, Bronen R, Krol G: MR imaging of the cranial meninges with emphasis on contrast enhancements and meningeal carcinomatosis. AJNR 10: 965–975, 1989
Ogawa T, Inugami A, Hatazawa J, Kanno I, Murakami M, Yasui N, Mineura K, Uemura K: Clinical Positron Emission Tomography for BrainTumors: comparison of Fludeoxyglucose F 18 and L-Methyl-11C-Methionine. AJNR 17: 345–353, Feb. 1996
Griffeth LK, Rich KM, Dehdashti F, Simpson JR, Fusselman MJ, McGuire AH, Siegel BA: Brain metastases from non-central nervous system tumors: evaluation with PET. Radiology 186(1): 37–44, 1993.
Kubota R, Kubota K, Yamada S, Tada M, Takahashi T, Iwata R, Tamahashi N: Methionine uptake by tumor tissue: a microradiographic comparison with FDG. J Nucl Med 36: 484–492, 1995
Langleben DD, Segall GM: PET in differentiation of recurrent brain tumor from radiation injury. J Nucl Med 41: 1861–1867, 2000
Janus TJ, Kim EE, Tilbury R, Bruner JM, Yung WK. Use of [18F] fluorodeoxyglucose positron emission tomography in patients with primary malignant brain tumors. Ann Neurol 14: 524–527, 1993
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Padma, M., Jacobs, M., Kraus, G. et al. 11C-methionine PET Imaging of Leptomeningeal Metastases from Primary Breast Cancer – a Case Report. J Neurooncol 55, 39–44 (2001). https://doi.org/10.1023/A:1012973504866
Issue Date:
DOI: https://doi.org/10.1023/A:1012973504866