Meningeosis neoplastica: Der Einfluss von Tumorart und Liquorzellzahl auf die Diagnostik

Neoplastic meningitis: How MRI and CSF cytology are influenced by CSF cell count and tumor type

by Peter Prömmel
Doctoral thesis
Date of Examination:2016-07-27
Date of issue:2016-07-26
Advisor:Prof. Dr. Herwig Strik
Referee:Prof. Dr. Herwig Strik
Referee:PD Dr. Florian Freimann
Referee:Prof. Dr. Michael Knauth
Persistent Address: http://dx.doi.org/10.53846/goediss-5724

 

 

Files in this item

Name:Dissertation_NM_MRT_Zyto_korrigierte Endvers...pdf
Size:579.Kb
Format:PDF

The following license files are associated with this item:

Abstract

English

Background. Although CSF cytology and MRI are standard methods to diagnose neoplastic meningitis (NM), this complication of neoplastic disease remains difficult to detect. We therefore reevaluated the sensitivity of gadolinium (GD)-enhanced MRI and cerebrospinal-fluid (CSF)-cytology and the relevance of tumor type and CSF cell count. Methods.We retrospectively identified 111 cases of NM diagnosed in our CSF laboratory since 1990 with complete documentation of both MRI and CSF cytology. 37 had haematological and 74 solid neoplasms. CSF cell counts were increased in 74 and normal in 37 patients. Results. In hematological neoplasms, MRI was positive in 49% and CSF cytology in 97%. In solid tumors, the sensitivity of MRI was 78% and of cytology 80%. With normal CSF cell counts, MRI was positive in 59% (50% hematological, 72% solid malignancies) and CSF cytology in 76% (92% in hematological, 68% in solid neoplasms). In cases of elevated cell counts, the sensitivity of MRI was 72% (50% for hematological, 83% for solid malignancies) and of CSF cytology 91% (100% for haematological and 85% for solid neoplasms). 91% of cytologically positive cases were diagnosed at first and another 7% at second lumbar puncture. Routine protein analyses had a low sensitivity in detecting NM. Conclusions. The high overall sensitivity of MRI was only confirmed for NM from solid tumors and for elevated CSF cell counts.With normal cell counts and haematological neoplasms, CSF-cytology was superior to MRI. None of the analysed routine CSF proteins had an acceptable sensitivity and specificity in detecting leptomeningeal disease.
Keywords: Neoplastic meningitis; MRI; CSF cytology; sensitivity
Schlagwörter: Meningeosis neoplastica; MRT; Liquor-Zytologie; Sensitivität
 
Statistik