Potential of F-18 PET/CT in the Detection of Leptomeningeal Metastasis

Abstract

Leptomeningeal metastasis (LM) is a rare but increasingly common condition in which malignant cells migrate to the meninges. The gold standard for diagnosing LM is detection of cancer cells in the cerebrospinal fluid (CSF). Contrast enhanced-magnetic resonance imaging (CE-MRI) is also used to diagnose LM. We describe a case of LM in which CE-MRI of the neuroaxis was initially negative for meningeal enhancement but F-18 fluorodeoxyglucose positron-emission tomography/computed tomography (F-18 FDG PET/CT) revealed hypermetabolism within the lumbar spinal canal. Positive F-18 FDG PET findings have rarely been reported in LM and, to our knowledge, have never been reported in the context of initially negative CE-MRI scanning of the neuroaxis. F-18 FDG PET/CT may represent an alternative modality for diagnosing LM in patients who are unable to undergo CE-MRI and/or LP or in patients for whom initial CE-MRI and/or LP are negative for LM.

Keywords

leptomeningeal metastasis PET imaging MR imaging

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References

Clarke

Perez

Jacks

. Leptomeningeal metastases in the MRI era. Neurology. 2010; 74 (18): 1449–1454. doi: 10.1212/WNL.0b013e3181dc1a69.

Glass

Melamed

Chernik

. Malignant cells in cerebrospinal fluid (CSF): The meaning of a positive CSF cytology. Neurology. 1979; 29 (10): 1369–1375. doi: 10.1212/WNL.29.10.1369.

Wasserstrom

Glass

Posner

. Diagnosis and treatment of leptomeningeal metastases from solid tumors: Experience with 90 patients. Cancer. 1982; 49 (4): 759–772.

Singh

Leeds

Ginsberg

. MR Imaging of leptomeningeal metastases: Comparison of three sequences. Am J Neuroradiol. 2002; 23 (5): 817–821.

Sze

Soletsky

Bronen

. MR imaging of the cranial meninges with emphasis on contrast enhancement and meningeal carcinomatosis. Am J Neuroradiol. 1989; 10 (5): 965–975.

Bendszus

Warmuth-Metz

Burger

. Diagnosing dural metastases: The value of 1H magnetic resonance spectroscopy. Neuroradiology. 2001; 43 (4): 285–289. doi: 10.1007/s002340000419.

Freilich

Krol

Deangelis

. Neuroimaging and cerebrospinal fluid cytology in the diagnosis of leptomeningeal metastasis. Ann Neurol. 1995; 38 (1): 51–57. doi: 10.1002/ana.410380111.

Straathof

de Bruin

Dippel

. The diagnostic accuracy of magnetic resonance imaging and cerebrospinal fluid cytology in leptomeningeal metastasis. J Neurol. 1999; 246 (9): 810–814. doi: 10.1007/s004150050459.

Maroldi

Ambrosi

Farina

. Metastatic disease of the brain: Extra-axial metastases (skull, dura, leptomeningeal) and tumour spread. Eur Radiol. 2005; 15 (3): 617–626. doi: 10.1007/s00330-004-2617-5.

10.

Bendell

Domchek

Burstein

. Central nervous system metastases in women who receive trastuzumab-based therapy for metastatic breast carcinoma. Cancer. 2003; 97 (12): 2972–2977. doi: 10.1002/cncr.11436.

11.

Komori

Delbeke

. Leptomeningeal carcinomatosis and intramedullary spinal cord metastases from lung cancer: Detection with FDG positron emission tomography. Clin Nucl Med. 2001; 26 (11): 905–907. doi: 10.1097/00003072-200111000-00001.

12.

Rangarajan

Purandare

Luthra

. 18F-FDG uptakes in leptomeningeal metastases from carcinoma of the breast on a positron emission tomography/computerized tomography study. Indian J Cancer. 2007; 44 (3): 115. doi: 10.4103/0019-509X.38944.

13.

Renard

Dufour

Collombier

. Cerebral FDG-PET hypermetabolism in carcinomatous meningitis. Eur Neurol. 2011; 66 (6): 332–333. doi: 10.1159/000334096.

14.

Rohren

Provenzale

Barboriak

. Screening for cerebral metastases with FDG PET in patients undergoing whole-body staging of non-central nervous system malignancy. Radiology. 2003; 226 (1): 181–187. doi: 10.1148/radiol.2261010920.

15.

Shinohara

Kosaka

Okamura

. FDG-PET in meningeal lymphomatosis. J Neurol Neurosurg Psychiatry. 2007; 78 (9): 974. doi: 10.1136/jnnp.2007.116129.

16.

Padma

Jacobs

Kraus

. 11C-methionine PET imaging of leptomeningeal metastases from primary breast cancer – a case report. J Neurooncol. 2001: 55 (1): 39–44. doi: 10.1023/A:1012973504866.