Cranial computed tomographic abnormalities in leptomeningeal metastasis

Area of Science:

• Neuro-oncology
• Radiology
• Oncology

Background:

• Leptomeningeal metastasis (LM) is a serious complication of cancer.
• Accurate diagnosis of LM is crucial for patient management.
• Cerebrospinal fluid (CSF) cytology is a primary diagnostic tool for LM.

Purpose of the Study:

• To evaluate the utility of cranial computed tomographic (CT) scans in detecting leptomeningeal metastasis.
• To correlate CT findings with CSF cytology results in cancer patients.

Main Methods:

• Retrospective review of 111 cancer patients with positive CSF cytology for malignancy.
• Analysis of cranial CT scans performed within 2 weeks of lumbar puncture.
• Identification of specific CT findings suggestive of leptomeningeal metastasis.

Main Results:

• 57.6% of patients underwent cranial CT scans.
• 34.3% of scanned patients showed CT findings indicative of LM (e.g., enhancement patterns, hydrocephalus).
• 59.6% of patients with CT-detected LM also had parenchymal metastases.

Conclusions:

• Cranial CT is valuable in diagnosing leptomeningeal metastasis in cancer patients with positive CSF cytology.
• Communicating hydrocephalus should be presumed to be due to LM unless proven otherwise.
• Identifying LM can significantly impact treatment strategies for patients with brain metastases.