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Evolution of computed tomographic abnormalities in leptomeningeal metastases
Annals of Neurology
|January 1, 1985
Summary
Cranial computed tomographic (CT) scans reveal that meningeal enhancement and hydrocephalus often precede clinical symptoms in leptomeningeal metastases. These CT findings can indicate disease progression before cerebrospinal fluid analysis confirms tumor cells.
Area of Science:
- Neuro-oncology
- Radiology
- Neurology
Background:
- Leptomeningeal metastases (LM) represent a significant challenge in neuro-oncology, often associated with poor prognosis.
- Early detection and monitoring of LM are crucial for timely intervention and management.
- Cranial computed tomographic (CT) imaging plays a role in evaluating brain involvement, but its predictive value for clinical manifestation requires further elucidation.
Purpose of the Study:
- To correlate the evolution of CT abnormalities with clinical symptoms and cerebrospinal fluid (CSF) findings in patients with leptomeningeal metastases.
- To investigate the temporal relationship between specific CT findings and the onset of symptoms or detection of tumor cells in CSF.
Main Methods:
- Serial cranial computed tomographic (CT) scans were obtained from 25 patients diagnosed with leptomeningeal metastases.
- CT findings, including meningeal enhancement, cistern and sulci obliteration, hydrocephalus, transependymal edema, and cortical nodules, were analyzed.
- Correlation was performed between CT findings, clinical symptom progression, and cerebrospinal fluid cytology results.
Main Results:
- In nearly one-third of patients, specific CT findings like meningeal enhancement and hydrocephalus preceded clinical symptoms.
- Ventriculomegaly (72%) was frequently observed, often associated with sulcal/cisternal obliteration.
- Multiple small, enhancing cortical nodules were detected before symptom onset or CSF tumor cell discovery in some cases.
Conclusions:
- Cranial CT findings can precede clinical symptoms and CSF tumor cell detection in leptomeningeal metastases, suggesting its utility in early diagnosis.
- The evolution of CT abnormalities, including meningeal enhancement and hydrocephalus, provides valuable information for monitoring disease progression.
- Radiographic changes on CT scans can offer insights into the disease course even before definitive clinical or CSF confirmation.