Imaging features of leptomeningeal metastases
Imaging features of leptomeningeal metastases
复制标题
DOI：
10.1016/s0009-9260(99)91181-9
复制
发表时间：
1999-11-01
影响因子：
2.6
通讯作者：
Sellar, RJ
中科院分区：
文献类型：
--
作者：
Collie, DA;Brush, JP;Sellar, RJ
目的：为了评估的范围内的外观，和各种方法诊断的准确性leptomeningeal metastases. MATERIALS AND METHODS：在一项回顾性研究中，所有患者的笔记和影像学与放射学和/或脑脊液细胞学诊断的leptomeningeal metastases（LM）被确定，并评估以下：年龄和性别、原发肿瘤类型、表现症状、最初的放射学和细胞学诊断、放射学表现和诊断后的生存时间。CSF细胞学和影像学诊断LM之间的不一致性也noted.Results：41例阳性病例（36名女性）的LM被确定超过2.7年的时间（诊断的基础上：仅成像-19例，仅细胞学-6，两者-16例）。平均年龄48岁，最常见的原发肿瘤是乳腺癌（27/41）。三分之二的患者至少有一个颅神经或脊神经麻痹。40%（10/25）的增强CT显示正常，24%（6/25）的LM被误认为实质性疾病。脑脊液细胞学检查阳性率为85%（22/26），增强CT检查全部阳性（25/25）。软脑膜强化和结节是最常见的表现（67%），但其他表现包括结节性病变，神经强化和白色改变。结论：软脑膜转移性疾病预后差，治疗方案可能不同于脑实质转移性疾病。三分之二的患者CT正常或误导，CSF细胞学检查也可能阴性。钆增强T1加权MRI补充CSF细胞学检查，是非血液学原发肿瘤和疑似LM患者的首选检查。牧羊犬D.一、Brush，J.P.，Lammie，G. a.等人（1999）Clinical Radiology 54，765 - 771。(C)1999年皇家放射科医师学院。
AIM: To assess the range of appearances, and accuracy of various methods of diagnosing leptomeningeal metastases.MATERIALS AND METHODS: In a retrospective study, the notes and imaging of all patients with a radiological and/or CSF cytological diagnosis of leptomeningeal metastasis (LM) were identified, and assessed for the following: age and sex, primary tumour type, presenting symptoms, initial radiological and cytological diagnosis, radiological appearances and length of survival following diagnosis. Discordance between the CSF cytology and radiological diagnosis of LM was also noted.RESULTS: 41 positive cases (36 female) of LM were identified over a 2.7 year period (diagnosis based on: imaging only - 19 cases, cytology only - 6, both - 16 cases). The average age was 48 years, and the most frequent primary tumour was breast carcinoma (27/41). Two thirds of patients presented with at least one cranial or spinal nerve palsy. Where performed, contrast-enhanced CT was normal in 40% (10/25), with LM mistaken for parenchymal disease in a further 24% (6/25). CSF cytology was positive in 85% (22/26), Gadolinium-enhanced CT was positive in all cases where it was performed (25/25). Pial enhancement and nodularity was the commonest finding (67%), but other manifestations included nodular disease, neural enhancement and white matter changes. Prognosis was uniformly poor.CONCLUSION: Leptomeningeal metastatic disease has a poor prognosis, and treatment regimen may differ from those of parenchymal CNS metastases. CT is normal or misleading in two thirds of patients, and CSF cytology may also be negative. Gadolinium-enhanced T1-weighted MRI complements CSF cytology, and is the investigation of choice in patients with a non-haematological primary tumour and suspected LM. Collie, D. A., Brush, J. P., Lammie, G. A. et al. (1999) Clinical Radiology 54, 765-771. (C) 1999 The Royal College of Radiologists.