Department of Radiology and Nuclear Medicine, Sana Hospitals Lübeck, Kronsforder Allee 71-73, 23560 Lübeck, Germany.
Eur J Radiol. 2012 May;81(5):974-8. doi: 10.1016/j.ejrad.2011.02.020. Epub 2011 Mar 2.
An early diagnosis of meningitis is important to improve patients' survival. Data about a direct comparison of cerebrospinal fluid cytology (CSF-cytology) and MRI are very limited. Therefore, the aim of this study was to compare these two diagnostic modalities in diagnosing meningitis in patients with hematopoietic and solid malignancies.
In 68 patients suspicious for neoplastic meningitis, cytology and MRI (1.5 T) was performed. The meningeal, pial or intraparenchymal hyperintense signal or contrast enhancement was correlated to the final CNS diagnosis and to cytology.
44 patients (64.7%) had neoplastic meningitis, 21 patients (30.9%) had non-neoplastic meningitis. The sensitivity to diagnose meningeal disease was 49.2% for MRI and 95.4% for cytology (p<0.001). In patients with neoplastic meningitis, sensitivity was 45.5% for MRI and 93.2% for cytology (p<0.001). In patients with infectious meningitis, sensitivity was 57.1% for MRI and 100% for cytology (p=0.0013). In patients with solid tumors, the sensitivity was 84.6% for both diagnostic methods. The sensitivity for MRI was low in patients with leukemia (20.0%) and lymphoma (37.5%). The positive predictive value (PPV) for MRI to differentiate infectious from neoplastic meningitis was high in patients with infectious meningitis (75.0%), in patients with lymphoma (83.3%), and in patients with solid tumors (72.7%). Ppv was low in patients with leukemia (33.3%).
Diagnostic value of MRI for diagnosing meningitis is especially limited in patients with hematopoietic malignancies. MRI better detected leptomeningeal involvement caused by solid tumors than by leukemia or lymphoma. The ppv to specify neoplastic meningitis depends on tumor subtype.
早期诊断脑膜炎对于提高患者生存率至关重要。目前关于脑脊液细胞学（CSF 细胞学）和 MRI 直接比较的数据非常有限。因此，本研究旨在比较这两种诊断方法在诊断血液系统和实体恶性肿瘤患者脑膜炎中的作用。
对 68 例疑似患有恶性脑膜炎的患者进行细胞学和 MRI（1.5 T）检查。脑膜、软脑膜或脑实质高信号或增强与最终中枢神经系统诊断和细胞学检查相关。
44 例（64.7%）患者患有肿瘤性脑膜炎，21 例（30.9%）患者患有非肿瘤性脑膜炎。MRI 诊断脑膜疾病的敏感性为 49.2%，细胞学检查为 95.4%（p<0.001）。在肿瘤性脑膜炎患者中，MRI 的敏感性为 45.5%，细胞学检查为 93.2%（p<0.001）。在感染性脑膜炎患者中，MRI 的敏感性为 57.1%，细胞学检查为 100%（p=0.0013）。在实体瘤患者中，两种诊断方法的敏感性均为 84.6%。在白血病（20.0%）和淋巴瘤（37.5%）患者中，MRI 的敏感性较低。对于感染性脑膜炎患者，MRI 对区分感染性和肿瘤性脑膜炎的阳性预测值（PPV）较高（75.0%），对于淋巴瘤患者（83.3%）和实体瘤患者（72.7%）也较高，但对于白血病患者则较低（33.3%）。
MRI 对诊断脑膜炎的诊断价值在血液恶性肿瘤患者中尤其有限。MRI 比白血病或淋巴瘤更能检测到实体瘤引起的软脑膜受累。PPV 要确定肿瘤性脑膜炎，取决于肿瘤亚型。
