Neoplastic meningitis: How MRI and CSF cytology are influenced by CSF cell count and tumor type.
BACKGROUND
Although CSF cytology and MRI are standard methods to diagnose neoplastic meningitis (NM), this complication of neoplastic disease remains difficult to detect. We therefore reevaluated the sensitivity of gadolinium (GD)-enhanced MRI and cerebrospinal-fluid (CSF)-cytology and the relevance of tumor type and CSF cell count.


METHODS
We retrospectively identified 111 cases of NM diagnosed in our CSF laboratory since 1990 with complete documentation of both MRI and CSF cytology. 37 had haematological and 74 solid neoplasms. CSF cell counts were increased in 74 and normal in 37 patients.


RESULTS
In hematological neoplasms, MRI was positive in 49% and CSF cytology in 97%. In solid tumors, the sensitivity of MRI was 80% and of cytology 78%. With normal CSF cell counts, MRI was positive in 59% (50% hematological, 72% solid malignancies) and CSF cytology in 76% (92% in hematological, 68% in solid neoplasms). In cases of elevated cell counts, the sensitivity of MRI was 72% (50% for hematological, 83% for solid malignancies) and of CSF cytology 91% (100% for haematological and 85% for solid neoplasms). 91% of cytologically positive cases were diagnosed at first and another 7% at second lumbar puncture. Routine protein analyses had a low sensitivity in detecting NM.


CONCLUSIONS
The high overall sensitivity of MRI was only confirmed for NM from solid tumors and for elevated CSF cell counts. With normal cell counts and haematological neoplasms, CSF-cytology was superior to MRI. None of the analysed routine CSF proteins had an acceptable sensitivity and specificity in detecting leptomeningeal disease.
Department of Neurology, Medical School, University of Goettingen, Germany ; Department of Neurosurgery, University of Zurich, Switzerland.
P
P
Prömmel
Department of Neuroradiology, Medical School, University of Goettingen, Germany.
S
S
Pilgram-Pastor
Institute of Surgical Research, University of Marburg, Baldinger Stra β e, 35043 Marburg, Germany.
H
H
Sitter
Department of Neuroradiology, Medical School, University of Goettingen, Germany ; Department of Neuroradiology, University of Hamburg, Germany.
J-H
JH
Buhk
Department of Neurology, Medical School, University of Goettingen, Germany ; Department of Neurology, University of Marburg, Baldinger Stra β e, 35043 Marburg, Germany.
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H
Strik
D001932:Brain Neoplasms / Q000134:cerebrospinal fluid* / Q000000981:diagnostic imaging*; D002452:Cell Count; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008581:Meningitis / Q000134:cerebrospinal fluid* / Q000000981:diagnostic imaging*; D011859:Radiography; D012189:Retrospective Studies