Neoplastic meningitis MRI

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sujit Routray, M.D. [2]

Overview

Brain MRI is helpful in the diagnosis of neoplastic meningitis. On MRI, neoplastic meningitis is characterized by normal T1- and T2-weighted images. On contrast administration, there may be leptomeningeal enhancement scattered over the brain in a 'sugar coated' manner, which is fairly diagnostic for neoplastic meningitis.

MRI

• Brain MRI is helpful in the diagnosis of neoplastic meningitis with sensitivity and specificity estimated to be around 66-98% and 77-97.7% respectively.
• The most sensitive MRI component are contrast-enhanced T1 weight and fluid attenuated inversion recovery (FLAIR) sequences.
• Findings that are fairly suggestive of neoplastic meningitis include nodular meningeal tumor, meningeal thickening > 3 mm, and a subjectively strong contrast enhancement. A smooth contrast enhancement of the meninges is typical for inflammatory, nonneoplastic meningitis.
• On MRI, neoplastic meningitis is characterized by:

MRI component	Findings
T1	Usually normal
T2	Usually normal
T1 with contrast	Leptomeningeal enhancement scattered over the brain in a 'sugar coated' manner (diagnostic)
Fluid-attenuated inversion recovery (FLAIR)	Abnormally elevated signal within sulci

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