Institute of Clinical Radiology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany.
Diagnostic and Interventional Neuroradiology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.
Neuroradiology. 2019 Jul;61(7):775-782. doi: 10.1007/s00234-019-02215-y. Epub 2019 Apr 18.
To assess the prevalence of false-positive meningeal contrast enhancement in patients with solid tumors who were undergoing chemotherapy.
A total of 2572 magnetic resonance imaging (MRI) examinations of the brain were retrospectively evaluated by two readers for the presence of pathological meningeal contrast enhancement conspicuous for neoplastic meningitis. These patients either had malignant melanoma, breast or lung cancer, or lymphoma. The reference standards were cerebrospinal fluid cytology results and follow-up MRI. In cases with pathological contrast enhancement that decreased upon follow-up and non-malignant cytology, the enhancement pattern was further described as pial or dural, local or diffuse, or supra- or infra-tentorial. Moreover, the underlying therapy regimes were assessed.
The final study cohort included 78 patients (51 females, median age 57 years), of which 11 patients (14.1%) had a repeated non-malignant cytology ('pseudomeningeosis'). In one case, this finding, a granular pleocytosis, was attributed to previous radiotherapy. Of the remaining patients, seven were receiving multimodal, immunotherapy-based therapy regimens. Patients with unsuspicious cytology had a predominantly supratentorial distribution pattern in comparison to patients with neoplastic meningitis.
The overall prevalence of the presence of false-positive meningeal contrast enhancement is low (< 1%) and not associated with specific imaging patterns. We hypothesize that there is a possible relationship between immunotherapy and 'pseudomeningeosis'. Therefore, in all cases with suspected neoplastic meningitis, the cerebrospinal fluid should be analyzed to confirm the diagnosis, especially in patients undergoing immunotherapy.
评估正在接受化疗的实体瘤患者中脑膜对比增强假阳性的发生率。
通过两位读者对 2572 例脑磁共振成像（MRI）检查进行回顾性评估，以确定是否存在病理性脑膜对比增强，表现为肿瘤性脑膜炎。这些患者患有恶性黑色素瘤、乳腺癌或肺癌或淋巴瘤。参考标准是脑脊液细胞学结果和随访 MRI。对于在随访期间和非恶性细胞学检查中减少的病理性对比增强病例，进一步描述增强模式为脑膜或硬脑膜、局部或弥漫性、幕上或幕下。此外，还评估了潜在的治疗方案。
最终的研究队列包括 78 名患者（51 名女性，中位年龄 57 岁），其中 11 名患者（14.1%）有重复的非恶性细胞学检查结果（“假性脑膜病”）。在一个病例中，这种发现，即颗粒性白细胞增多，归因于先前的放射治疗。在其余患者中，有 7 名患者正在接受多模式免疫治疗方案。与患有肿瘤性脑膜炎的患者相比，细胞学检查无异常的患者脑膜对比增强主要分布在幕上。
脑膜对比增强假阳性的总体发生率较低（<1%），且与特定的影像学模式无关。我们假设免疫治疗与“假性脑膜病”之间可能存在一定的关系。因此，在所有疑似肿瘤性脑膜炎的病例中，都应分析脑脊液以确认诊断，特别是在接受免疫治疗的患者中。
