The diagnostic accuracy of magnetic resonance imaging and cerebrospinal fluid cytology in leptomeningeal metastasis

Straathof, C.S.M.; Bruin, Hein G. de; Dippel, Diederik W.J.; Vecht, Ch.J.

doi:10.1007/s004150050459

Cited by 205 publications

(134 citation statements)

References 12 publications

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“…When three high-volume LPs are obtained, the sensitivity improves to 90% 3 . CE-MRI of the brain and/or spine should be performed when the clinical suspicion for LM is high because positive findings allow clinicians to diagnose LM even with negative CSF findings or without performing LP altogether [7][8][9] . A majority of patients with LM secondary to breast cancer will have co-existing paren-…”

Section: Discussionmentioning

confidence: 99%

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Potential of F-18 PET/CT in the Detection of Leptomeningeal Metastasis

et al. 2014

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SUMMARY -Leptomeningeal metastasis (LM) is a rare but increasingly common condition in which malignant cells migrate to the meninges. The gold standard for diagnosing LM is detection of cancer cells in the cerebrospinal fluid (CSF). Contrast enhanced-magnetic resonance imaging (CE-MRI) is also used to diagnose LM. We describe a case of LM in which CE-MRI of the neuroaxis was initially negative for meningeal enhancement but F-18 fluorodeoxyglucose positron-emission tomography/computed tomography (F-18 FDG PET/CT) revealed hypermetabolism within the lumbar spinal canal. Positive F-18 FDG PET findings have rarely been reported in LM and, to our knowledge, have never been reported in the context of initially negative CE-MRI scanning of the neuroaxis. F-18 FDG PET/CT may represent an alternative modality for diagnosing LM in patients who are unable to undergo CE-MRI and/or LP or in patients for whom initial CE-MRI and/or LP are negative for LM.

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Section: Discussionmentioning

confidence: 99%

“…Because CE-MRI meningeal enhancement can be caused by a number of conditions, the specificity of MRI for diagnosis of LM is heavily dependent upon pre-test probability but can be as high as 77% 8 . In this case, initial CE-MRI of the entire neuroaxis showed no obvious meningeal enhancement to suggest LM.…”

Section: Case Reportmentioning

confidence: 99%

Potential of F-18 PET/CT in the Detection of Leptomeningeal Metastasis

et al. 2014

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“…Despite its low sensitivity, CSF cytologic examination has been the gold standard for leptomeningeal metastasis because of its 100% specificity (16). If clinical suspicion is high, gadolinium-enhanced MRI of the brain and spine can provide definitive evidence of leptomeningeal metastasis, even without a positive CSF cytology (17,18).…”

Section: Cytomorphologymentioning

confidence: 99%

Flow cytometric characterization of cerebrospinal fluid cells

Graaf

Jongste

Kraan

et al. 2011

Cytometry Part B Clinical

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Flow cytometry facilitates the detection of a large spectrum of cellular characteristics on a per cell basis, determination of absolute cell numbers and detection of rare events with high sensitivity and specificity. White blood cell (WBC) counts in cerebrospinal fluid (CSF) are important for the diagnosis of many neurological disorders. WBC counting and differential can be performed by microscopy, hematology analyzers, or flow cytometry. Flow cytometry of CSF is increasingly being considered as the method of choice in patients suspected of leptomeningeal localization of hematological malignancies. Additionally, in several neuroinflammatory diseases such as multiple sclerosis and paraneoplastic neurological syndromes, flow cytometry is commonly performed to obtain insight into the immunopathogenesis of these diseases. Technically, the low cellularity of CSF samples, combined with the rapidly declining WBC viability, makes CSF flow cytometry challenging. Comparison of flow cytometry with microscopic and molecular techniques shows that each technique has its own advantages and is ideally combined. We expect that increasing the number of flow cytometric parameters that can be simultaneously studied within one sample, will further refine the information on CSF cell subsets in low-cellular CSF samples and enable to define cell populations more accurately. V C 2011 International Clinical Cytometry Society

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“…[6,7] Although cytologic analysis of CSF is considered the gold standard for diagnosing LMD, MRI and CSF cytology are complementary, as MRI can show evidence of LMD when CSF cytology does not and vice versa. [8] To avoid delay in treatment, the diagnosis of LMD needs to be made as early as possible.…”

Section: Introductionmentioning

confidence: 99%

Association between 18F-FDG PET/CT and MRI appearance of spinal leptomeningeal disease before and after treatment at a tertiary referral center

Papasozomenos

Guha-Thakurta

Mayer³

et al. 2015

JST

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Objective: Leptomeningeal disease (LMD), the presence of metastasis in the subarachnoid space, has devastating implications if left untreated. The gold standard for LMD diagnosis is cytologic analysis of cerebrospinal fluid (CSF); MRI is also used to evaluate suspected LMD. The purpose of this study was to compare the appearance of LMD in the spinal canal on 18 F-FDG PET/CT imaging with the appearance of LMD on MRI and with CSF cytology. Methods: In twenty-one patients with cytologically-proven spinal LMD, findings on 18 F-FDG PET/CT, MRI, and CSF cytology at diagnosis of LMD and after the initiation of treatment for LMD were retrospectively reviewed. Results: At diagnosis of LMD, abnormal 18 F-FDG avidity was demonstrated in the spinal canal in six patients, and the anatomic distribution of 18 F-FDG activity corresponded to the sites of LMD on MRI. All six of these patients were then treated with intrathecal chemotherapy. Follow-up 18 F-FDG PET/CT and MRI were obtained in four of the six cases. In all four cases, normalization of 18 F-FDG activity in the spinal canal and reduction of enhancement on MRI corresponded to the cytologic response to treatment, as determined by CSF analysis. Conclusion: 18 F-FDG avidity in the spinal canal greater than the normal contents of the canal can suggest spinal LMD. This abnormal avidity may be detected before the diagnosis of LMD has been established with MRI or CSF cytology. The spinal canal should be routinely evaluated on 18 F-FDG PET/CT in patients with suspected LMD so that appropriate treatment is initiated.

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The diagnostic accuracy of magnetic resonance imaging and cerebrospinal fluid cytology in leptomeningeal metastasis

Cited by 205 publications

References 12 publications

Potential of F-18 PET/CT in the Detection of Leptomeningeal Metastasis

Potential of F-18 PET/CT in the Detection of Leptomeningeal Metastasis

Flow cytometric characterization of cerebrospinal fluid cells

Association between 18F-FDG PET/CT and MRI appearance of spinal leptomeningeal disease before and after treatment at a tertiary referral center

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