Use of magnetic resonance imaging to detect neoplastic meningitis: Limited use in leukemia and lymphoma but convincing results in solid tumors

doi:10.1016/j.ejrad.2011.02.020

European Journal of Radiology

Volume 81, Issue 5, May 2012, Pages 974-978

https://doi.org/10.1016/j.ejrad.2011.02.020 Get rights and content

Abstract

Background

An early diagnosis of meningitis is important to improve patients’ survival. Data about a direct comparison of cerebrospinal fluid cytology (CSF-cytology) and MRI are very limited. Therefore, the aim of this study was to compare these two diagnostic modalities in diagnosing meningitis in patients with hematopoietic and solid malignancies.

Methods

In 68 patients suspicious for neoplastic meningitis, cytology and MRI (1.5 T) was performed. The meningeal, pial or intraparenchymal hyperintense signal or contrast enhancement was correlated to the final CNS diagnosis and to cytology.

Results

44 patients (64.7%) had neoplastic meningitis, 21 patients (30.9%) had non-neoplastic meningitis. The sensitivity to diagnose meningeal disease was 49.2% for MRI and 95.4% for cytology (p < 0.001). In patients with neoplastic meningitis, sensitivity was 45.5% for MRI and 93.2% for cytology (p < 0.001). In patients with infectious meningitis, sensitivity was 57.1% for MRI and 100% for cytology (p = 0.0013). In patients with solid tumors, the sensitivity was 84.6% for both diagnostic methods. The sensitivity for MRI was low in patients with leukemia (20.0%) and lymphoma (37.5%). The positive predictive value (PPV) for MRI to differentiate infectious from neoplastic meningitis was high in patients with infectious meningitis (75.0%), in patients with lymphoma (83.3%), and in patients with solid tumors (72.7%). Ppv was low in patients with leukemia (33.3%).

Conclusion

Diagnostic value of MRI for diagnosing meningitis is especially limited in patients with hematopoietic malignancies. MRI better detected leptomeningeal involvement caused by solid tumors than by leukemia or lymphoma. The ppv to specify neoplastic meningitis depends on tumor subtype.

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

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Use of magnetic resonance imaging to detect neoplastic meningitis: Limited use in leukemia and lymphoma but convincing results in solid tumors

Abstract

Background

Methods

Results

Conclusion

Introduction

Section snippets

Patients

Results

Discussion

Conclusion

Leukemic and lymphomatous meningitis: incidence, prognosis and treatment

J Neurooncol

Leptomeningeal metastases in the MRI era

Neurology

Diagnostic tools for neoplastic meningitis: detecting disease, identifying patient risk, and determining benefit of treatment

Semin Oncol

Br J Haematol

Neuroimaging and cerebrospinal fluid cytology in the diagnosis of leptomeningeal metastases

Ann Neurol