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State of Art of LM Radiographic Diagnosis: Anatomic and Functional Imaging

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Radiopharmaceuticals in the Management of Leptomeningeal Metastasis

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Abstract

This chapter describes the challenges faced in the initial assessment of leptomeningeal disease (LMD) and the imaging techniques used for the diagnosis and surveillance. First, a background description of LMD and the clinical, laboratory, and radiological criteria used are provided. Second, the imaging techniques including MRI, CSF flow studies, and PET/CT are discussed. The imaging features and locations of LMD and pitfalls to be avoided when interpreting imaging studies are provided. Finally, the Response Assessment in Neuro-Oncology (RANO) proposal for standardizing the initial diagnosis and follow-up criteria of patients with LMD is discussed.

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References

  1. Clarke JL, Perez HR, Jacks LM, Panageas KS, Deangelis LM. Leptomeningeal metastases in the MRI era. Neurology. 2010;74:1449–54.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Kaplan JG, DeSouza TG, Farkash A, Shafran B, Pack D, Rehman F, Fuks J, Portenoy R. Leptomeningeal metastases: comparison of clinical features and laboratory data of solid tumors, lymphomas and leukemias. J Neurooncol. 1990;9:225–9.

    Article  CAS  PubMed  Google Scholar 

  3. Kesari S, Batchelor TT. Leptomeningeal metastases. Neurol Clin. 2003;21:25–66.

    Article  PubMed  Google Scholar 

  4. Little JR, Dale AJ, Okazaki H. Meningeal carcinomatosis. Clinical manifestations. Arch Neurol. 1974;30:138–43.

    Article  CAS  PubMed  Google Scholar 

  5. Olson ME, Chernik NL, Posner JB. Infiltration of the leptomeninges by systemic cancer. A clinical and pathologic study. Arch Neurol. 1974;30:122–37.

    Article  CAS  PubMed  Google Scholar 

  6. Posner JB, Chernik NL. Intracranial metastases from systemic cancer. Adv Neurol. 1978;19:579–92.

    CAS  PubMed  Google Scholar 

  7. Shapiro WR, Young DF, Mehta BM. Methotrexate: distribution in cerebrospinal fluid after intravenous, ventricular and lumbar injections. N Engl J Med. 1975;293:161–6.

    Article  CAS  PubMed  Google Scholar 

  8. Theodore WH, Gendelman S. Meningeal carcinomatosis. Arch Neurol. 1981;38:696–9.

    Article  CAS  PubMed  Google Scholar 

  9. Wasserstrom WR, Glass JP, Posner JB. Diagnosis and treatment of leptomeningeal metastases from solid tumors: experience with 90 patients. Cancer. 1982;49:759–72.

    Article  CAS  PubMed  Google Scholar 

  10. Gleissner B, Chamberlain MC. Neoplastic meningitis. Lancet Neurol. 2006;5:443–52.

    Article  PubMed  Google Scholar 

  11. Debnam JM, Mayer RR, Chi TL, Ketonen L, Weinberg JS, Wei W, Groves MD, Guha-Thakurta N. Most common sites on MRI of intracranial neoplastic leptomeningeal disease. J Clin Neurosci. 2017;45:252–6.

    Article  PubMed  Google Scholar 

  12. Le Rhun E, Taillibert S, Chamberlain MC. Carcinomatous meningitis: leptomeningeal metastases in solid tumors. Surg Neurol Int. 2013;4:S265–88.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Chowdhary S, Chamberlain M. Leptomeningeal metastases: current concepts and management guidelines. J Natl Compr Cancer Netw. 2005;3:693–703.

    Article  Google Scholar 

  14. Mack F, Baumert BG, Schafer N, Hattingen E, Scheffler B, Herrlinger U, Glas M. Therapy of leptomeningeal metastasis in solid tumors. Cancer Treat Rev. 2016;43:83–91.

    Article  CAS  PubMed  Google Scholar 

  15. Jaeckle KA. Neoplastic meningitis from systemic malignancies: diagnosis, prognosis and treatment. Semin Oncol. 2006;33:312–23.

    Article  PubMed  Google Scholar 

  16. Nayar G, Ejikeme T, Chongsathidkiet P, Elsamadicy AA, Blackwell KL, Clarke JM, Lad SP, Fecci PE. Leptomeningeal disease: current diagnostic and therapeutic strategies. Oncotarget. 2017;8:73312–28.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Omar AI, Mason WP. Leptomeningeal metastases. In: Neurologic complications of cancer. 2nd ed. New York: Oxford University Press, Inc; 2009. p. 240–81.

    Google Scholar 

  18. Groves MD. Leptomeningeal disease. Neurosurg Clin N Am. 2011;22:67–78.

    Article  PubMed  Google Scholar 

  19. Beauchesne P. Intrathecal chemotherapy for treatment of leptomeningeal dissemination of metastatic tumours. Lancet Oncol. 2010;11:871–9.

    Article  CAS  PubMed  Google Scholar 

  20. Chamberlain M, Junck L, Brandsma D, Soffietti R, Ruda R, Raizer J, Boogerd W, Taillibert S, Groves MD, Rhun EL, Walker J, van den Bent M, Wen PY, Jaeckle KA. Leptomeningeal metastases: a RANO proposal for response criteria. Neuro-Oncology. 2017;19:484–92.

    PubMed  Google Scholar 

  21. Brem SS, Bierman PJ, Brem H, Butowski N, Chamberlain MC, Chiocca EA, DeAngelis LM, Fenstermaker RA, Friedman A, Gilbert MR, Hesser D, Junck L, Linette GP, Loeffler JS, Maor MH, Michael M, Moots PL, Morrison T, Mrugala M, Nabors LB, Newton HB, Portnow J, Raizer JJ, Recht L, Shrieve DC, Sills AK Jr, Vrionis FD, Wen PY. National Comprehensive Cancer Network, central nervous system. J Natl Compr Cancer Netw. 2011;9:352–400.

    Article  Google Scholar 

  22. Glantz MJ, Cole BF, Glantz LK, Cobb J, Mills P, Lekos A, Walters BC, Recht LD. Cerebrospinal fluid cytology in patients with cancer: minimizing false-negative results. Cancer. 1998;82:733–9.

    Article  CAS  PubMed  Google Scholar 

  23. Lossos A, Siegal T. Spinal subarachnoid hemorrhage associated with leptomeningeal metastases. J Neuro-Oncol. 1992;12:167–71.

    Article  CAS  Google Scholar 

  24. Papasozomenos H, Guha-Thakurta N, Mayer RR, Weinberg JS, Groves MD, Debnam JM. Association between 18F-FDG PET/CT and MRI appearance of spinal leptomeningeal disease before and after treatment at a tertiary referral center. J Solid Tumors. 2016;6:1–8.

    PubMed  Google Scholar 

  25. Klein P, Haley EC, Wooten GF, VandenBerg SR. Focal cerebral infarctions associated with perivascular tumor infiltrates in carcinomatous leptomeningeal metastases. J Neuro-Oncol. 1992;12:167–71.

    Google Scholar 

  26. DeAngelis LM. Current diagnosis and treatment of leptomeningeal metastasis. J Neurooncol. 1998;38:245–52.

    Article  CAS  PubMed  Google Scholar 

  27. Lin N, Dunn IF, Glantz M, Allison DL, Jensen R, Johnson MD, Friedlander RM, Kesari S. Benefit of ventriculoperitoneal cerebrospinal fluid shunting and intrathecal chemotherapy in neoplastic meningitis: a retrospective, case-controlled study. J Neurosurg. 2011;115:730–6.

    Article  PubMed  Google Scholar 

  28. Dietemann JL, Correia Bernardo R, Bogorin A, Abu Eid M, Koob M, Nogueira T, Vargas MI, Fakhoury W, Zöllner G. Normal and abnormal meningeal enhancement: MRI features. J Radiol. 2005;86:1659–83.

    Article  CAS  PubMed  Google Scholar 

  29. Chamberlain MC, Sandy AD, Press GA. Leptomeningeal metastasis: a comparison of gadolinium-enhanced MR and contrast-enhanced CT of the brain. Neurology. 1990;40:435–8.

    Article  CAS  PubMed  Google Scholar 

  30. Collie DA, Brush JP, Lammie GA, Grant R, Kunkler I, Leonard R, Gregor A, Sellar RJ. Imaging features of leptomeningeal metastases. Clin Radiol. 1999;54:765–71.

    Article  CAS  PubMed  Google Scholar 

  31. Park JH, Kim YJ, Lee JO, Lee KW, Kim JH, Bang SM, Chung JH, Kim JS, Lee JS. Clinical outcomes of leptomeningeal metastasis in patients with non-small cell lung cancer in the modern chemotherapy era. Lung Cancer. 2012;76:387–92.

    Article  PubMed  Google Scholar 

  32. Rudnicka H, Niwińska A, Murawska M. Breast cancer leptomeningeal metastasis: the role of multimodality treatment. J Neuro-Oncol. 2007;84:57–62.

    Article  Google Scholar 

  33. Morris PG, Reiner AS, Szenberg OR. Leptomeningeal metastasis from non-small cell lung cancer: survival and the impact of whole brain radiotherapy. J Thorac Oncol. 2012;7:382–5.

    Article  PubMed  Google Scholar 

  34. Pauls S, Fischer AC, Brambs HJ, Fetscher S, Höche W, Bommer M. Use of magnetic resonance imaging to detect neoplastic meningitis: limited use in leukemia and lymphoma but convincing results in solid tumors. Eur J Radiol. 2012;81:974–8.

    Article  PubMed  Google Scholar 

  35. Chamberlain MC. Comprehensive neuraxis imaging in leptomeningeal metastasis: a retrospective case series. CNS Oncol. 2013;2:121–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Enzmann DR, Rubin JB, DeLaPaz R, Wright A. Cerebrospinal fluid pulsation: benefits and pitfalls in MR imaging. Radiology. 1986;161:773–8.

    Article  CAS  PubMed  Google Scholar 

  37. Clatot F, Philippin-Lauridant G, Ouvrier MJ. Clinical improvement and survival in breast cancer leptomeningeal metastasis correlate with the cytologic response to intrathecal chemotherapy. J Neuro-Oncol. 2009;95:421–6.

    Article  CAS  Google Scholar 

  38. Burke JW, Podrasky AE, Bradley WG Jr. Meninges: benign postoperative enhancement on MR images. Radiology. 1990;174:99–102.

    Article  CAS  PubMed  Google Scholar 

  39. Leach JL, Jones BV, Tomsick TA, Stewart CA, Balko MG. Normal appearance of arachnoid granulations on contrast-enhanced CT and MR of the brain: differentiation from dural sinus disease. AJNR Am J Neuroradiol. 1996;17(8):1523–32.

    CAS  PubMed  PubMed Central  Google Scholar 

  40. Mittl RL Jr, Yousem DM. Frequency of unexplained meningeal enhancement in the brain after lumbar puncture. AJNR Am J Neuroradiol. 1994;15(4):633–8.

    PubMed  PubMed Central  Google Scholar 

  41. Weiss HD, Walker MD, Wiernik PH. Neurotoxicity of commonly used antineoplastic drugs. N Engl J Med. 1974;291:75–81.

    Article  CAS  PubMed  Google Scholar 

  42. Jacob LA, Sreevatsa A, Chinnagiriyappa LK, Dasappa L, Suresh TM, Babu G. Methotrexate-induced chemical meningitis in patients with acute lymphoblastic leukemia/lymphoma. Ann Indian Acad Neurol. 2015;18:206–9.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Muscal JA, Jones JY, Paulino AC, Bertuch AA, Su J, Woo SY, Mahoney DH Jr, Chintagumpala M. Changes mimicking new leptomeningeal disease after intensity-modulated radiotherapy for medulloblastoma. Int J Radiat Oncol Biol Phys. 2009;73:214–21.

    Article  PubMed  Google Scholar 

  44. Chamberlain MC, Kormanik PA. Prognostic significance of 111indium-DTPA CSF flow studies in leptomeningeal metastases. Neurology. 1996;46:1674–7.

    Article  CAS  PubMed  Google Scholar 

  45. Chamberlain MC. Radioisotope CSF flow studies in leptomeningeal metastases. J Neurooncol. 1998;38:135–40.

    Article  CAS  PubMed  Google Scholar 

  46. Mason WP, Yeh SD, DeAngelis LM. 111Indium-diethylenetriamine pentaacetic acid cerebrospinal fluid flow studies predict distribution of intrathecally administered chemotherapy and outcome in patients with leptomeningeal metastases. Neurology. 1998;50:438–44.

    Article  CAS  PubMed  Google Scholar 

  47. Grande ML, Rayo JI, Serrano J, Infante JR, Garcia L, Duran C, Gomez-Caminero F. Leptomeningeal carcinomatosis as only pathological finding at FDG-PET/CT in case of tumor marker elevation in breast cancer. Indian J Nucl Med. 2014;29:53–4.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Tripathi M, Jain N, Jaimini A, Garg G, D'souza MM, Sharma R, Grover RK, Mondal A. Demonstration of diffuse leptomeningeal metastasis in a treated case of medulloblastoma with F-18 FDG PET/CT. Clin Nucl Med. 2009;34:530.

    Article  PubMed  Google Scholar 

  49. Intriago B, Danús M, Añaños M, Trampal C, Montero M, Calvo N. 18F-FDG PET detection of spinal leptomeningeal metastases from cerebral glioblastoma multiforme. Eur J Nucl Med Mol Imaging. 2011;38:1392.

    Article  PubMed  Google Scholar 

  50. Short RG, Bal S, German JP, Poelstra RJ, Kardan A. Potential of F-18 PET/CT in the detection of leptomeningeal metastasis. Neuroradiol J. 2014;27:685–9.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Carra BJ, Clemenshaw MN. Intracranial leptomeningeal carcinomatosis from breast cancer detected on 18F-FDG PET. J Nucl Med Technol. 2015;43:227–8.

    Article  PubMed  Google Scholar 

  52. Ortapamuk H, Demir MK. Intracranial leptomeningeal carcinomatosis in three cases from breast cancer demonstrated on F-18 fluorodeoxyglucose positron emission tomography/computerized tomography. Indian J Nucl Med. 2017;32:16–8.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Padma MV, Jacobs M, Kraus G, Collins M, Dunigan K, Mantil J. 11C-methionine PET imaging of leptomeningeal metastases from primary breast cancer—a case report. J Neuro-Oncol. 2001;55:39–44.

    Article  CAS  Google Scholar 

  54. Komori T, Delbeke D. Leptomeningeal carcinomatosis and intramedullary spinal cord metastases from lung cancer: detection with FDG positron emission tomography. Clin Nucl Med. 2001;26:905–7.

    Article  CAS  PubMed  Google Scholar 

  55. Bhatt G, Li XF, Jain A, Sharma VR, Pan J, Rai A, Rai SN, Civelek AC. The normal variant 18F FDG uptake in the lower thoracic spinal cord segments in cancer patients without CNS malignancy. Am J Nucl Med Mol Imaging. 2013;10:317–25.

    Google Scholar 

  56. Chamberlain MC, Kormanik P, Jaeckle KA, Glantz M. 111Indiumdiethylenetriamine pentaacetic acid CSF flow studies predict distribution of intrathecally administered chemotherapy and outcome in patients with leptomeningeal metastases. Neurology. 1999;52:216–7.

    Article  CAS  PubMed  Google Scholar 

  57. Quijano S, Lopez A, Manuel SJ, Panizo C, Debén G, Castilla C, Antonio García-Vela J, Salar A, Alonso-Vence N, González-Barca E, Peñalver FJ, Plaza-Villa J, Morado M, García-Marco J, Arias J, Briones J, Ferrer S, Capote J, Nicolás C, Orfao A, Spanish Group for the Study of CNS Disease in NHL. Identification of leptomeningeal disease in aggressive B-cell non-Hodgkin’s lymphoma: improved sensitivity of flow cytometry. J Clin Oncol. 2009;27:1462–9.

    Article  CAS  PubMed  Google Scholar 

  58. Kraan J, Gratama JW, Haioun C, Orfao A, Plonquet A, Porwit A, Quijano S, Stetler-Stevenson M, Subira D, Wilson W. Flow cytometric immunophenotyping of cerebrospinal fluid. Curr Protoc Cytom. 2008;Chapter 6:Unit 6.25.

    PubMed  Google Scholar 

  59. Nayak L, Fleisher M, Gonzalez-Espinosa R, Lin O, Panageas K, Reiner A, Liu CM, Deangelis LM, Omuro A. Rare cell capture technology for the diagnosis of leptomeningeal metastases in slide tumors. Neurology. 2013;80:1598–605.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Neuroradiology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA

    J. Matthew Debnam & T. Linda Chi

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  1. J. Matthew Debnam
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  2. T. Linda Chi
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Correspondence to J. Matthew Debnam .

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Editors and Affiliations

  1. Dept of Nuclear Med, Unit No 1483, U Texas MD Anderson Cancer Ctr, Houston, TX, USA

    Franklin C.L. Wong

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Debnam, J.M., Chi, T.L. (2022). State of Art of LM Radiographic Diagnosis: Anatomic and Functional Imaging. In: Wong, F.C. (eds) Radiopharmaceuticals in the Management of Leptomeningeal Metastasis. Springer, Cham. https://doi.org/10.1007/978-3-031-14291-8_2

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  • DOI: https://doi.org/10.1007/978-3-031-14291-8_2

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