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Neoplastic vs inflammatory meningeal enhancement with Gd-DTPA
M E Phillips1, T J Ryals, S A Kambhu
1Department of Radiology, University of Iowa College of Medicine, Iowa City.
Abstract:
We studied 40 consecutive patients clinically suspected of having meningeal disease, in whom both Gd-diethylenetriamine pentaacetic acid (DTPA)-enhanced magnetic resonance (MR) examinations and CSF or surgical pathologic samples were obtained. The MR examinations were retrospectively reviewed for the presence of abnormal meningeal enhancement, as well as pattern and site of enhancement. The MR findings correctly correlated with pathology results in 15 of 19 patients with suspected tumor involvement (including one true negative) and in 18 of 21 patients with suspected inflammatory meningeal conditions (including 2 true negatives). Pial enhancement was demonstrated in 62% (10 of 16) of patients with meningitis and in 29% (4 of 14) of patients with meningeal neoplastic involvement. A diffuse meningeal distribution was commonly present with inflammatory conditions (69%, 11 of 16). A nodular appearance was seen in two patients with tumor involvement of the meninges as well as in a single case of sarcoidosis but was not seen with infectious meningitis. Our data suggest that Gd-DTPA-enhanced MR imaging is sensitive to the presence of meningeal pathology but is nonspecific as to disease entity. Recognition of certain MR patterns in conjunction with clinical presentation may improve diagnosis and management of patients with suspected meningeal disease.
Insights
Gadolinium-DTPA-enhanced MRI is sensitive for detecting meningeal disease. While patterns like diffuse enhancement suggest inflammation and nodular enhancement may indicate tumors, MRI is nonspecific for definitive diagnosis.
Area of Science:
- Neuroradiology
- Neurology
- Medical Imaging
Background:
- Meningeal disease diagnosis relies on clinical suspicion and invasive procedures.
- Accurate differentiation between inflammatory and neoplastic meningeal conditions is crucial for patient management.
Purpose of the Study:
- To evaluate the diagnostic performance of gadolinium-diethylenetriamine pentaacetic acid (DTPA)-enhanced magnetic resonance (MR) imaging in patients with suspected meningeal disease.
- To identify characteristic MR imaging patterns associated with specific meningeal pathologies.
Main Methods:
- Retrospective review of 40 patients with suspected meningeal disease who underwent Gd-DTPA-enhanced MR imaging and had confirmed pathology.
- Analysis of MR findings for abnormal meningeal enhancement, including pattern and site.
- Correlation of MR findings with cerebrospinal fluid (CSF) or surgical pathology results.
Main Results:
- Gd-DTPA-enhanced MR imaging demonstrated sensitivity for meningeal pathology.
- Pial enhancement was more frequent in meningitis (62%) than neoplastic involvement (29%).
- Diffuse meningeal enhancement was common in inflammatory conditions (69%), while nodular enhancement was observed in tumors and sarcoidosis but not infectious meningitis.
Conclusions:
- Gd-DTPA-enhanced MR imaging is a sensitive tool for detecting meningeal pathology.
- Specific MR patterns, such as diffuse or nodular enhancement, can suggest certain disease types but are not definitive.
- Integrating MR findings with clinical presentation may improve the diagnosis and management of suspected meningeal diseases.