Use of magnetic resonance imaging to detect neoplastic meningitis: Limited use in leukemia and lymphoma but convincing results in solid tumors
Introduction
The spread of cancer cells into the cerebrospinal fluid (CSF) is called neoplastic meningitis. It is a rare, but devastating complication of solid tumors with an incidence of 5–15%. However, in leukemia and lymphoma the rate is similar with an estimated incidence of up to 20% [1], but in contrast to solid tumors, the prognosis seems to be much better with a small proportion of patients be cured [2]. An early diagnosis of a meningeal involvement of the disease is important to improve patients’ survival. Cerebrospinal fluid cytology is the gold-standard to diagnose neoplastic and non-neoplastic meningitis. Contrast-enhanced magnetic resonance imaging (MRI) as a non-invasive imaging method is also routinely performed in patients with typical clinical symptoms. In the literature for both methods the sensitivity is reported to be limited, however for the CSF-cytology the reported specificity is around 95%, for MRI the reported specificity is as low as 50% [3]. To the best of our knowledge, published data reporting about a direct comparison of these two diagnostic modalities are very limited. Therefore, the aim of the study was to compare the diagnostic value of MRI with the results from CSF cytology in patients with neoplastic and non-neoplastic meningitis.
Section snippets
Patients
Between 2000 and 2010 we performed both cytology and contrast enhanced MRI in patients suspicious for neoplastic meningitis. Patients were primarily recruited from the department of hematology. Therefore, the study based on a selected patient cohort: most of the patients were diagnosed with leukemia or lymphoma, and they were treated according to standard protocols. Both examinations were done in patients suffering from typical clinical symptoms for meningitis such as strong headache, nuchal
Results
There were 34 women and 34 men with an average age of 55.6 years (median 57.5 years) ranging from 21 to 77 years. The final diagnoses of all patients are shown in Table 1a, Table 1b. The different solid tumors comprise breast cancer, prostate cancer, gastric cancer, and lung cancer. 44 patients (64.7%) had neoplastic meningitis, 21 patients (30.9%) had inflammatory meningitis. In two patients (2.9%) the final diagnosis remained unknown. The underlying illness of those patients were relapse of
Discussion
Inflammatory and malignant meningitis is a rare, but severe complication of various infections and many malignancies. Treatment decisions are based on rapid and reliable diagnosis, an early diagnosis is indispensable to improve the prognosis and patients’ survival. Up to now, the CSF cytology is the gold standard to diagnose meningeal disease. In clinical routine, contrast enhanced MRI was performed to increase the diagnostic accuracy. There are no data available which compare directly CSF
Conclusion
In conclusion, diagnostic value of MRI for the diagnosis of meningitis is limited in patients with hematopoietic malignancy. MRI had the same sensitivity in diagnosing neoplastic meningitis compared to CSF cytology in patients with solid tumors; for this subgroup of patients, MRI could replace cytology to detect meningitis. FLAIR sequence as well as contrast-enhanced T1-weighted images are the most important sequences to diagnose meningitis. Further studies with a large patient cohort and based
References (10)
- et al.
Leukemic and lymphomatous meningitis: incidence, prognosis and treatment
J Neurooncol
(2005) - et al.
Leptomeningeal metastases in the MRI era
Neurology
(2010) - et al.
Diagnostic tools for neoplastic meningitis: detecting disease, identifying patient risk, and determining benefit of treatment
Semin Oncol
(2009) - et al.
Br J Haematol
(2004) - et al.
Neuroimaging and cerebrospinal fluid cytology in the diagnosis of leptomeningeal metastases
Ann Neurol
(1995)
Cited by (43)
Successful Treatment of Ocular Chronic Lymphocytic Leukemia with Ibrutinib: Case Report and Review of the Literature
2020, Leukemia Research ReportsCitation Excerpt :This case too demonstrated persistent focal disruption of the photoreceptor outer segments where there was initial leukemic involvement. [23] Diagnostic work-up typically involves neuroimaging; however, MRI has a lower sensitivity for detection of meningeal involvement in primary CNS lymphoma [20-37.5%] compared to solid tumors [24,25] and the absence of MRI abnormalities may not rule out CNS CLL. CSF examination, while important, is challenging, because of the low burden of CLL cells in the CSF as well as the risk of peripheral blood contamination during the procedures, increasing false-positive rates.
Overview of metastatic disease of the central nervous system
2018, Handbook of Clinical NeurologyCitation Excerpt :In all patients with suspected LM, a cranial and spinal MRI with gadolinium and lumbar puncture for CSF should be performed. MRI is effective for diagnosis in 83–85% of solid tumor cases, but this sensitivity decreases in hematologic malignancies (Freilich et al., 1995; Clarke et al., 2010; Pauls et al., 2012). Definitive contrast enhancement of cranial nerves or nodules along the spinal cord, roots, or cauda equina is sufficient to make the diagnosis even without positive CSF cytology.
Meningeal carcinomatosis in lung cancer
2017, Revue des Maladies Respiratoires ActualitesState of Art of LM Radiographic Diagnosis: Anatomic and Functional Imaging
2022, Radiopharmaceuticals in the Management of Leptomeningeal MetastasisIsolated T-cell acute lymphoblastic leukemic optic disc infiltration
2021, American Journal of Hematology