Diagnosis of meningeal metastatic spread, once considered rare, is increasingly common due to the longer survival of cancer patients and to the latest diagnostic techniques, especially magnetic resonance and improved methods for the cytological investigation of CSF. Metastases can arise from a primary tumour of the CNS or other organs. The neoplasms most often implicated in meningeal dissemination are carcinomas of the breast, lung, lymph nodes and medulloblastomas. The exact route of tumour cell spread remains unsettled although the main hypotheses include: CSF spread, dissemination through the blood or through the perivascular and perineural lymph vessels, or through the perivascular spaces of Virchow-Robin, spread to the dura mater from the bone marrow of the skull or vertebrae and direct extension of primary CNS tumours to the pia and/or ependyma. Anatomopathological findings also vary widely ranging from irregular separation of the dura mater from the diploe following accelerated periosteal growth of tumour cells, the formation of isolated subdural nodules attached to the aura mater, diffuse thickening of the aura mater which may present haemorrhage due to infiltration of the aural veins and capillaries (haemorrhagic pachymeningitis), invasion of the subarachnoid space with the formation of masses attached to the arachnoid and, lastly, diffuse infiltration of the leptomeninges by an opaque exudate following the subarachnoid space. The different anatomopathological findings present distinct topographic and morphologic MR correlates, especially after iv. administration of paramagnetic contrast medium. Topographical features include dural meningeal carcinomatosis with curvilinear enhancement beneath the bone table which does not follow the convolutions, leptomeningeal carcinomatosis with thin linear enhancement following the convolutions and medullary surface and, lastly, mixed features. Morphologically, meningeal infiltration may be nodular, diffuse or focal linear or mixed. In our series we encountered several differences between MR findings in meningeal carcinomatosis from primary CNS tumours as opposed to tumours originating elsewhere. CNS tumours presented mixed aural and leptomeningeal topographical features with both a linear and nodular morphology. Primary tumours in other organs mainly presented a dural topography with a diffuse linear morphology.
Cranial and spinal meningeal carcinomatosis MR findings
Soffietti R.Last
1997-01-01
Abstract
Diagnosis of meningeal metastatic spread, once considered rare, is increasingly common due to the longer survival of cancer patients and to the latest diagnostic techniques, especially magnetic resonance and improved methods for the cytological investigation of CSF. Metastases can arise from a primary tumour of the CNS or other organs. The neoplasms most often implicated in meningeal dissemination are carcinomas of the breast, lung, lymph nodes and medulloblastomas. The exact route of tumour cell spread remains unsettled although the main hypotheses include: CSF spread, dissemination through the blood or through the perivascular and perineural lymph vessels, or through the perivascular spaces of Virchow-Robin, spread to the dura mater from the bone marrow of the skull or vertebrae and direct extension of primary CNS tumours to the pia and/or ependyma. Anatomopathological findings also vary widely ranging from irregular separation of the dura mater from the diploe following accelerated periosteal growth of tumour cells, the formation of isolated subdural nodules attached to the aura mater, diffuse thickening of the aura mater which may present haemorrhage due to infiltration of the aural veins and capillaries (haemorrhagic pachymeningitis), invasion of the subarachnoid space with the formation of masses attached to the arachnoid and, lastly, diffuse infiltration of the leptomeninges by an opaque exudate following the subarachnoid space. The different anatomopathological findings present distinct topographic and morphologic MR correlates, especially after iv. administration of paramagnetic contrast medium. Topographical features include dural meningeal carcinomatosis with curvilinear enhancement beneath the bone table which does not follow the convolutions, leptomeningeal carcinomatosis with thin linear enhancement following the convolutions and medullary surface and, lastly, mixed features. Morphologically, meningeal infiltration may be nodular, diffuse or focal linear or mixed. In our series we encountered several differences between MR findings in meningeal carcinomatosis from primary CNS tumours as opposed to tumours originating elsewhere. CNS tumours presented mixed aural and leptomeningeal topographical features with both a linear and nodular morphology. Primary tumours in other organs mainly presented a dural topography with a diffuse linear morphology.
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