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Leptomeningeal metastasis

A comparison of gadolinium-enhanced MR and contrast-enhanced CT of the brain

Departments of Neurosciences (Dr. Chamberlain) and Radiology (Drs. Sandy and Press), University of California, San Diego. San Diego, CA.

We evaluated 14 consecutive patients with leptomeningeal metastasis prospectively, using both T1-weighted (T1W) gadolinium-DTPA-enhanced MR (Gd-MR) and contrast-enhanced CT (CE-CT). Thirteen had positive CSF cytology; the remaining patient had an atypical CSF lymphocytosis and primary CNS lymphoma. The patients (8M/6F) ranged in age from 8 to 70 years (median, 42 years). Tumor histology included 3 systemic and 2 primary CNS lymphomas, 3 breast carcinomas, 2 leukemias, 1 malignant schwannoma, 1 small cell lung cancer, 1 prostate cancer, and 1 melanoma. Both imaging methods demonstrated parenchymal volume loss equally well in all patients. Gd-MR revealed abnormal enhancement of meninges or parenchyma in 10 patients, including all 5 patients with positive CE-CT. Neither technique revealed any foci of abnormal enhancement in 4 patients. Gd-MR was superior to CE-CT in demonstrating and quantifying enhancing subarachnoid and parenchymal nodules in 6 patients and in demonstrating sulcal, dural, cisternal, tentorial, and ependymal enhancement. Our findings indicate that T1W Gd-MR is the preferred imaging modality in leptomeningeal metastasis and suggest that CE-CT is unnecessary.

Address correspondence and reprint requests to Dr. Marc C. Chamberlain, University of California, San Diego, Department of Neurosciences, 225 Dickinson Street, H-815-B, San Diego, CA 92103.

Received June 19,1989. Accepted for publication in final form August 15,1989.

This article has been cited by other articles:

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