Meningeal Gd-DTPA enhancement in patients with malignancies

Nineteen patients with malignant diseases and pathologically enhancing meninges were studied by pre- and postcontrast (Gd-diethylene-triamine pentaacetic acid) magnetic resonance (MR) scans. Two patterns of enhancement were recognized: the dural (14 patients) and the leptomeningeal (mainly pial) (5 patients). Positive cytology was found in only 3 of the 14 patients with dural enhancement (21%), whereas in the remaining 11 patients we noted either nonspecific CSF findings such as elevated protein, high white blood cell count, and low glucose or entirely normal CSF. Four patients (80%) in the group with leptomeningeal enhancement showed positive cytology and one had normal CSF analysis. We conclude that meningeal enhancement as seen on MR imaging is a nonspecific finding and correlates well with positive cytology only when the more rare form of leptomeningeal enhancement is encountered.