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Incidence of meningeal enhancement on brain MRI secondary to lumbar puncture

Sarah Flanagan Wesley1, Rocio Garcia-Santibanez1, John Liang1

  • 1Department of Neurology, Icahn School of Medicine, Mount Sinai Beth Israel, New York, NY.

Neurology. Clinical Practice
|February 15, 2018
PubMed
Abstract

Insights

Unexplained meningeal enhancement after lumbar puncture (LP) is rare. This study found no significant difference in unexplained enhancement rates between patients who had an LP and those who did not, suggesting pre-LP brain MRI may not be necessary.

Area of Science:

  • Neurology
  • Radiology
  • Medical Imaging

Background:

  • Reactive meningeal enhancement on brain MRI is a common concern following lumbar puncture (LP).
  • The actual incidence of unexplained meningeal enhancement post-LP requires further investigation.

Purpose of the Study:

  • To determine the incidence of unexplained meningeal enhancement after lumbar puncture.
  • To compare the incidence of unexplained meningeal enhancement in patients with and without a preceding LP.

Main Methods:

  • Retrospective analysis of contrasted brain MRIs over 3 years at a NYC hospital.
  • Comparison of unexplained meningeal enhancement between patients with (cases) and without (controls) a prior LP within 30 days.
  • Fisher exact test used to compare enhancement rates, with variables like LP attempts and needle size recorded.

Main Results:

  • Out of 77 cases with prior LP, 1 (1.2%) showed unexplained meningeal enhancement.
  • None of the 707 controls (no prior LP) had unexplained meningeal enhancement.
  • The difference in unexplained enhancement between groups was not statistically significant (p=0.098).

Conclusions:

  • Iatrogenic meningeal enhancement from LP, excluding trauma or hypotension, is rare.
  • The incidence of unexplained meningeal enhancement is not higher after LP compared to controls.
  • Current practice of delaying LP until after brain MRI may not be evidence-based when LP is indicated.

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