MR of cranial and spinal meningeal carcinomatosis: comparison with CT and myelography.

Thirty-nine patients with histologically proved primary neoplasms, focal neurologic deficits, and positive CSF cytology were evaluated by enhanced cranial CT and MR, or complete myelography and MR of the spine. Intracranial abnormalities were noted on CT in 56% of cases and included abnormal enhancement of subarachnoid space and ventricular walls, ventricular dilatation, obliteration of cortical sulci, and enhancing nodules within the subarachnoid cisterns and lumen of the lateral ventricles. Although the degree of ventricular enlargement and intraventricular tumor deposits were equally well seen on CT and MR, involvement of ventricular walls, tentorium, subarachnoid cisterns, or subarachnoid space interpreted as abnormal enhancement on CT was not readily appreciated on routine T1- and T2-weighted spin-echo sequences. Forty-four percent of CT and 65% of MR studies were interpreted as normal. There was high correlation of myelographic findings with clinical diagnosis, and no false-negative myelograms. Nodular filling defects within the subarachnoid space, thickening and crowding of roots of the cauda equina, irregularity of individual roots, and scalloping of the subarachnoid membranes were demonstrated. MR was rather insensitive in detecting these changes, revealing a definite abnormality of the subarachnoid space in 27% of patients with positive myelograms. False-negative interpretation of MR of the spine was made in 44% of cases.