Gd-DTPA Enhancement of CSF in Meningeal Carcinomatosis

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Abstract
We report four cases of CSF enhancement secondary to meningeal carcinomatosis observed during MRI. Only one case has been reported previously. Four patients ranging from 4 to 20 years of age, and all having primary or secondary CNS neoplasms, were examined by cranial and/or spinal MRI before and after Gd-DTPA administration. Three of the patients had additional delayed imaging, and subtraction was used in one case. All four patients demonstrated CSF enhancement after Gd-DTPA administration, which increased on delayed imaging and was more apparent following subtraction. Three of the four patients died within 5 months of the MRI examination. CSF enhancement is uncommon, but when seen indicates massive tumor that coats the surface of the CNS. Detection of CNS enhancement may alter therapy; however prognosis may be poor when CSF enhancement is present. Delayed imaging and subtraction may improve detection of CSF enhancement.

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