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Neuroradiology. 2019 Jul;61(7):775-782. doi: 10.1007/s00234-019-02215-y. Epub 2019 Apr 18.

Meningeal enhancement depicted by magnetic resonance imaging in tumor patients: neoplastic meningitis or therapy-related enhancement?

Author information

1
Institute of Clinical Radiology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany. georghomann@web.de.
2
Diagnostic and Interventional Neuroradiology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany. georghomann@web.de.
3
Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.
4
Department of Radiology, Rems-Murr-Hospital, Am Jakobsweg 1, 71364, Winnenden, Germany.
5
Department of Neurosurgery and Interdisciplinary Division of Neurooncology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.
6
Department of Dermatology, Eberhard Karls University Tuebingen, Liebermeisterstr. 25, 72076, Tuebingen, Germany.
7
Diagnostic and Interventional Neuroradiology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.

Abstract

PURPOSE:

To assess the prevalence of false-positive meningeal contrast enhancement in patients with solid tumors who were undergoing chemotherapy.

METHODS:

A total of 2572 magnetic resonance imaging (MRI) examinations of the brain were retrospectively evaluated by two readers for the presence of pathological meningeal contrast enhancement conspicuous for neoplastic meningitis. These patients either had malignant melanoma, breast or lung cancer, or lymphoma. The reference standards were cerebrospinal fluid cytology results and follow-up MRI. In cases with pathological contrast enhancement that decreased upon follow-up and non-malignant cytology, the enhancement pattern was further described as pial or dural, local or diffuse, or supra- or infra-tentorial. Moreover, the underlying therapy regimes were assessed.

RESULTS:

The final study cohort included 78 patients (51 females, median age 57 years), of which 11 patients (14.1%) had a repeated non-malignant cytology ('pseudomeningeosis'). In one case, this finding, a granular pleocytosis, was attributed to previous radiotherapy. Of the remaining patients, seven were receiving multimodal, immunotherapy-based therapy regimens. Patients with unsuspicious cytology had a predominantly supratentorial distribution pattern in comparison to patients with neoplastic meningitis.

CONCLUSIONS:

The overall prevalence of the presence of false-positive meningeal contrast enhancement is low (< 1%) and not associated with specific imaging patterns. We hypothesize that there is a possible relationship between immunotherapy and 'pseudomeningeosis'. Therefore, in all cases with suspected neoplastic meningitis, the cerebrospinal fluid should be analyzed to confirm the diagnosis, especially in patients undergoing immunotherapy.

KEYWORDS:

Contrast-enhancement; False positive reactions; Immunotherapy; Magnetic resonance imaging; Meningeal carcinomatosis

PMID:
31001647
DOI:
10.1007/s00234-019-02215-y
[Indexed for MEDLINE]

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