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Leptomeningeal metastases: evaluation by gadolinium enhanced spinal magnetic resonance imaging
J M Gomori1, N Heching, T Siegal
1Department of Radiology, Hadassah Hebrew University Hospital, Ein-Karem, Jerusalem, Israel.
Background:
Leptomeningeal metastases are common in patients with metastatic systemic cancer or certain primary brain tumors. They may be unsuspected clinically and may be missed by cerebrospinal fluid (CSF) cytology. We undertook a retrospective study of the diagnostic value of gadolinium enhanced spinal MR imaging in patients with known or at high risk for leptomeningeal metastases (LM).
Material And Methods:
Ninety-six gadolinium enhanced MR examinations of the whole spine were performed in 61 patients (26 primary central nervous system tumors, 20 solid tumors and 15 lymphoproliferative neoplasms). All patients had detailed neurological evaluation and concomitant CSF examination.
Results:
Sixty-one MR's (62%) were positive, mostly in the lumbar spine. MR's were positive in 92% of patients with positive initial CSF cytology and in 60% of patients with negative CSF cytology. The MR examination was positive in 49% of those without clinical findings related to the spinal region. It showed disease beyond the symptomatic level in 42% of patients with spinal symptomatology. Multi-level spinal involvement was present in 57% of positive MR exams.
Conclusion:
Enhanced spinal MR is sensitive for the detection of neoplastic spinal seeding. It detects LM in about 50% of high risk patients with negative initial CSF cytology or no spinal symptoms.
Insights
Gadolinium-enhanced spinal MRI is a sensitive tool for detecting leptomeningeal metastases (LM) in cancer patients. This imaging technique aids in diagnosing spinal seeding, even when cerebrospinal fluid (CSF) cytology is negative or symptoms are absent.
Area of Science:
- Neurology
- Oncology
- Radiology
Background:
- Leptomeningeal metastases (LM) are a frequent complication in patients with advanced cancers or primary brain tumors.
- Clinical suspicion for LM can be low, and cerebrospinal fluid (CSF) cytology may fail to detect neoplastic infiltration.
- Accurate diagnostic methods are crucial for timely intervention in suspected leptomeningeal carcinomatosis.
Purpose of the Study:
- To evaluate the diagnostic utility of gadolinium-enhanced spinal magnetic resonance (MR) imaging.
- To assess the sensitivity of spinal MR in detecting leptomeningeal metastases (LM) in at-risk patients.
- To compare MR findings with cerebrospinal fluid (CSF) cytology and clinical presentation.
Main Methods:
- Retrospective analysis of 96 gadolinium-enhanced whole spine MR examinations in 61 patients.
- Patients included those with primary central nervous system tumors, solid tumors, and lymphoproliferative neoplasms.
- Correlated MR findings with neurological evaluations and CSF cytology results.
Main Results:
- Gadolinium-enhanced spinal MR imaging detected leptomeningeal metastases (LM) in 62% of examinations, predominantly in the lumbar spine.
- MR identified LM in 92% of patients with positive CSF cytology and 60% of those with negative CSF cytology.
- The examination was positive in 49% of asymptomatic patients and revealed disease beyond the symptomatic level in 42% of symptomatic patients.
Conclusions:
- Gadolinium-enhanced spinal MR imaging demonstrates high sensitivity for detecting neoplastic spinal seeding.
- Spinal MR is valuable for diagnosing leptomeningeal metastases (LM) in approximately 50% of high-risk patients with negative CSF cytology or no spinal symptoms.
- This imaging modality improves the detection rate of leptomeningeal metastases, especially in challenging clinical scenarios.