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CSF Disseminated Metastases
Kevin R. Moore, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Synonyms

                • Leptomeningeal carcinomatosis
                • Carcinomatous meningitis
                • Neoplastic meningitis
                • Drop metastases
              • Definitions

                • Spread of malignant tumor through subarachnoid spaces of brain and spine

              IMAGING

              • General Features

                • CT Findings

                  • MR Findings

                    • Nonvascular Interventions

                      • Imaging Recommendations

                        • Nuclear Medicine Findings

                          DIFFERENTIAL DIAGNOSIS

                            PATHOLOGY

                            • General Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Image Interpretation Pearls

                                            Selected References

                                            1. Diaz-Aguilar D et al: Simultaneous cerebrospinal fluid and hematologic metastases in a high-grade ependymoma. Surg Neurol Int. 9:93, 2018
                                            2. Tanaka H et al: Embryonal brain tumor with unknown primary lesion and massive cerebrospinal fluid dissemination: a case report. J Clin Neurosci. 54:125-8, 2018
                                            3. Utz MJ et al: Contrast-enhanced 3-dimensional fluid-attenuated inversion recovery sequences have greater sensitivity for detection of leptomeningeal metastases in pediatric brain tumors compared with conventional spoiled gradient echo sequences. J Pediatr Hematol Oncol. 40(4):316-9, 2018
                                            4. Yao H et al: Leukaemia hijacks a neural mechanism to invade the central nervous system. Nature. 560(7716):55-60, 2018
                                            5. Kralik SF et al: Radiological diagnosis of drop metastases from paediatric brain tumours using combination of 2D and 3D MRI sequences. Clin Radiol. 72(10):902.e13-902.e19, 2017
                                            6. Alvarez de Eulate-Beramendi S et al: Delayed leptomeningeal and subependymal seeding after multiple surgeries for supratentorial diffuse low-grade gliomas in adults. J Neurosurg. 120(4):833-9, 2014
                                            7. Chamberlain M et al: Leptomeningeal metastasis: a response assessment in neuro-oncology critical review of endpoints and response criteria of published randomized clinical trials. Neuro Oncol. 16(9):1176-85, 2014
                                            8. Knafo S et al: Intradural extramedullary spinal metastases of non-neurogenic origin: a distinct clinical entity or a subtype of leptomeningeal metastasis? A case-control study. Neurosurgery. 73(6):923-31; discussion 932, 2013
                                            9. Scott BJ et al: Leptomeningeal metastases in breast cancer. Am J Cancer Res. 3(2):117-26, 2013
                                            10. Lawton CD et al: Leptomeningeal spinal metastases from glioblastoma multiforme: treatment and management of an uncommon manifestation of disease. J Neurosurg Spine. 17(5):438-48, 2012
                                            11. Groves MD: Leptomeningeal disease. Neurosurg Clin N Am. 22(1):67-78, vii, 2011
                                            12. Clarke JL et al: Leptomeningeal metastases in the MRI era. Neurology. 74(18):1449-54, 2010
                                            13. Mahendru G et al: Meninges in cancer imaging. Cancer Imaging. 9 Spec No A:S14-21, 2009
                                            14. Chamberlain MC: Neoplastic meningitis. Oncologist. 13(9):967-77, 2008
                                            15. Lindsay A et al: Spinal leptomeningeal metastases following glioblastoma multiforme treated with radiotherapy. J Clin Neurosci. 9(6):725-8, 2002
                                            16. Singh SK et al: MR imaging of leptomeningeal metastases: comparison of three sequences. AJNR Am J Neuroradiol. 23(5):817-21, 2002
                                            17. Collie DA et al: Imaging features of leptomeningeal metastases. Clin Radiol. 54(11):765-71, 1999
                                            18. Straathof CS et al: The diagnostic accuracy of magnetic resonance imaging and cerebrospinal fluid cytology in leptomeningeal metastasis. J Neurol. 246(9):810-4, 1999
                                            19. van der Ree TC et al: Leptomeningeal metastasis after surgical resection of brain metastases. J Neurol Neurosurg Psychiatry. 66(2):225-7, 1999
                                            20. Chamberlain MC: Radioisotope CSF flow studies in leptomeningeal metastases. J Neurooncol. 38(2-3):135-40, 1998
                                            21. Formaglio F et al: Meningeal metastases: clinical aspects and diagnosis. Ital J Neurol Sci. 19(3): 133-49, 1998
                                            22. Gomori JM et al: Leptomeningeal metastases: evaluation by gadolinium enhanced spinal magnetic resonance imaging. J Neurooncol. 36(1):55-60, 1998
                                            23. Kallmes DF et al: High-dose gadolinium-enhanced MRI for diagnosis of meningeal metastases. Neuroradiology. 40(1):23-6, 1998
                                            24. Chamberlain MC et al: Carcinomatous meningitis secondary to breast cancer: predictors of response to combined modality therapy. J Neurooncol. 35(1):55-64, 1997
                                            25. Chamberlain MC: Comparative spine imaging in leptomeningeal metastases. J Neurooncol. 23(3):233-8, 1995
                                            26. Freilich RJ et al: Neuroimaging and cerebrospinal fluid cytology in the diagnosis of leptomeningeal metastasis. Ann Neurol. 38(1):51-7, 1995
                                            27. Glantz MJ et al: Diagnosis, management, and survival of patients with leptomeningeal cancer based on cerebrospinal fluid-flow status. Cancer. 75(12):2919-31, 1995
                                            28. Heinz R et al: Detection of cerebrospinal fluid metastasis: CT myelography or MR? AJNR Am J Neuroradiol. 16(5):1147-51, 1995
                                            29. Chua SL et al: Magnetic resonance imaging of leptomeningeal metastases to the spine. Singapore Med J. 34(3): 253-6, 1993
                                            30. Watanabe M et al: Correlation of MRI and clinical features in meningeal carcinomatosis. Neuroradiology. 35(7):512-5, 1993
                                            31. Lossos A et al: Spinal subarachnoid hemorrhage associated with leptomeningeal metastases. J Neurooncol. 12(2):167-71, 1992
                                            32. Schuknecht B et al: Spinal leptomeningeal neoplastic disease. Evaluation by MR, myelography and CT myelography. Eur Neurol. 32(1):11-6, 1992
                                            33. Yousem DM et al: Leptomeningeal metastases: MR evaluation. J Comput Assist Tomogr. 14(2):255-61, 1990
                                            34. Davis PC et al: Leptomeningeal metastasis: MR imaging. Radiology. 163(2):449-54, 1987
                                            35. Freeman CR et al: Primary malignant lymphoma of the central nervous system. Cancer. 58(5):1106-11, 1986
                                            36. Weissman DE et al: Simultaneous leptomeningeal and intramedullary spinal metastases in small cell lung carcinoma. Med Pediatr Oncol. 14(1):54-6, 1986
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Pathology

                                                    • Clinical Issues

                                                      • Diagnostic Checklist

                                                        TERMINOLOGY

                                                        • Synonyms

                                                          • Leptomeningeal carcinomatosis
                                                          • Carcinomatous meningitis
                                                          • Neoplastic meningitis
                                                          • Drop metastases
                                                        • Definitions

                                                          • Spread of malignant tumor through subarachnoid spaces of brain and spine

                                                        IMAGING

                                                        • General Features

                                                          • CT Findings

                                                            • MR Findings

                                                              • Nonvascular Interventions

                                                                • Imaging Recommendations

                                                                  • Nuclear Medicine Findings

                                                                    DIFFERENTIAL DIAGNOSIS

                                                                      PATHOLOGY

                                                                      • General Features

                                                                        • Microscopic Features

                                                                          CLINICAL ISSUES

                                                                          • Presentation

                                                                            • Demographics

                                                                              • Natural History & Prognosis

                                                                                • Treatment

                                                                                  DIAGNOSTIC CHECKLIST

                                                                                  • Consider

                                                                                    • Image Interpretation Pearls

                                                                                      Selected References

                                                                                      1. Diaz-Aguilar D et al: Simultaneous cerebrospinal fluid and hematologic metastases in a high-grade ependymoma. Surg Neurol Int. 9:93, 2018
                                                                                      2. Tanaka H et al: Embryonal brain tumor with unknown primary lesion and massive cerebrospinal fluid dissemination: a case report. J Clin Neurosci. 54:125-8, 2018
                                                                                      3. Utz MJ et al: Contrast-enhanced 3-dimensional fluid-attenuated inversion recovery sequences have greater sensitivity for detection of leptomeningeal metastases in pediatric brain tumors compared with conventional spoiled gradient echo sequences. J Pediatr Hematol Oncol. 40(4):316-9, 2018
                                                                                      4. Yao H et al: Leukaemia hijacks a neural mechanism to invade the central nervous system. Nature. 560(7716):55-60, 2018
                                                                                      5. Kralik SF et al: Radiological diagnosis of drop metastases from paediatric brain tumours using combination of 2D and 3D MRI sequences. Clin Radiol. 72(10):902.e13-902.e19, 2017
                                                                                      6. Alvarez de Eulate-Beramendi S et al: Delayed leptomeningeal and subependymal seeding after multiple surgeries for supratentorial diffuse low-grade gliomas in adults. J Neurosurg. 120(4):833-9, 2014
                                                                                      7. Chamberlain M et al: Leptomeningeal metastasis: a response assessment in neuro-oncology critical review of endpoints and response criteria of published randomized clinical trials. Neuro Oncol. 16(9):1176-85, 2014
                                                                                      8. Knafo S et al: Intradural extramedullary spinal metastases of non-neurogenic origin: a distinct clinical entity or a subtype of leptomeningeal metastasis? A case-control study. Neurosurgery. 73(6):923-31; discussion 932, 2013
                                                                                      9. Scott BJ et al: Leptomeningeal metastases in breast cancer. Am J Cancer Res. 3(2):117-26, 2013
                                                                                      10. Lawton CD et al: Leptomeningeal spinal metastases from glioblastoma multiforme: treatment and management of an uncommon manifestation of disease. J Neurosurg Spine. 17(5):438-48, 2012
                                                                                      11. Groves MD: Leptomeningeal disease. Neurosurg Clin N Am. 22(1):67-78, vii, 2011
                                                                                      12. Clarke JL et al: Leptomeningeal metastases in the MRI era. Neurology. 74(18):1449-54, 2010
                                                                                      13. Mahendru G et al: Meninges in cancer imaging. Cancer Imaging. 9 Spec No A:S14-21, 2009
                                                                                      14. Chamberlain MC: Neoplastic meningitis. Oncologist. 13(9):967-77, 2008
                                                                                      15. Lindsay A et al: Spinal leptomeningeal metastases following glioblastoma multiforme treated with radiotherapy. J Clin Neurosci. 9(6):725-8, 2002
                                                                                      16. Singh SK et al: MR imaging of leptomeningeal metastases: comparison of three sequences. AJNR Am J Neuroradiol. 23(5):817-21, 2002
                                                                                      17. Collie DA et al: Imaging features of leptomeningeal metastases. Clin Radiol. 54(11):765-71, 1999
                                                                                      18. Straathof CS et al: The diagnostic accuracy of magnetic resonance imaging and cerebrospinal fluid cytology in leptomeningeal metastasis. J Neurol. 246(9):810-4, 1999
                                                                                      19. van der Ree TC et al: Leptomeningeal metastasis after surgical resection of brain metastases. J Neurol Neurosurg Psychiatry. 66(2):225-7, 1999
                                                                                      20. Chamberlain MC: Radioisotope CSF flow studies in leptomeningeal metastases. J Neurooncol. 38(2-3):135-40, 1998
                                                                                      21. Formaglio F et al: Meningeal metastases: clinical aspects and diagnosis. Ital J Neurol Sci. 19(3): 133-49, 1998
                                                                                      22. Gomori JM et al: Leptomeningeal metastases: evaluation by gadolinium enhanced spinal magnetic resonance imaging. J Neurooncol. 36(1):55-60, 1998
                                                                                      23. Kallmes DF et al: High-dose gadolinium-enhanced MRI for diagnosis of meningeal metastases. Neuroradiology. 40(1):23-6, 1998
                                                                                      24. Chamberlain MC et al: Carcinomatous meningitis secondary to breast cancer: predictors of response to combined modality therapy. J Neurooncol. 35(1):55-64, 1997
                                                                                      25. Chamberlain MC: Comparative spine imaging in leptomeningeal metastases. J Neurooncol. 23(3):233-8, 1995
                                                                                      26. Freilich RJ et al: Neuroimaging and cerebrospinal fluid cytology in the diagnosis of leptomeningeal metastasis. Ann Neurol. 38(1):51-7, 1995
                                                                                      27. Glantz MJ et al: Diagnosis, management, and survival of patients with leptomeningeal cancer based on cerebrospinal fluid-flow status. Cancer. 75(12):2919-31, 1995
                                                                                      28. Heinz R et al: Detection of cerebrospinal fluid metastasis: CT myelography or MR? AJNR Am J Neuroradiol. 16(5):1147-51, 1995
                                                                                      29. Chua SL et al: Magnetic resonance imaging of leptomeningeal metastases to the spine. Singapore Med J. 34(3): 253-6, 1993
                                                                                      30. Watanabe M et al: Correlation of MRI and clinical features in meningeal carcinomatosis. Neuroradiology. 35(7):512-5, 1993
                                                                                      31. Lossos A et al: Spinal subarachnoid hemorrhage associated with leptomeningeal metastases. J Neurooncol. 12(2):167-71, 1992
                                                                                      32. Schuknecht B et al: Spinal leptomeningeal neoplastic disease. Evaluation by MR, myelography and CT myelography. Eur Neurol. 32(1):11-6, 1992
                                                                                      33. Yousem DM et al: Leptomeningeal metastases: MR evaluation. J Comput Assist Tomogr. 14(2):255-61, 1990
                                                                                      34. Davis PC et al: Leptomeningeal metastasis: MR imaging. Radiology. 163(2):449-54, 1987
                                                                                      35. Freeman CR et al: Primary malignant lymphoma of the central nervous system. Cancer. 58(5):1106-11, 1986
                                                                                      36. Weissman DE et al: Simultaneous leptomeningeal and intramedullary spinal metastases in small cell lung carcinoma. Med Pediatr Oncol. 14(1):54-6, 1986