eMedicine Specialties > Radiology > Brain/Spine

Leptomeningeal Carcinomatosis: Follow-up

Author: Andrew L Wagner, MD, Assistant Professor of Radiology, Instructional Faculty, University of Virginia School of Medicine; Director of Neuroradiology, Department of Radiology, Rockingham Memorial Hospital
Contributor Information and Disclosures

Updated: Feb 1, 2007

Intervention

Medicolegal Pitfalls

  • Failure to confirm leptomeningeal enhancement. As early diagnosis is important in LC, this can have serious consequences for the patient. Thus, administer contrast in all patients with a history of previous tumor or in those who have symptoms suggestive of LC, although the disease can be occult even with contrast. Noncontrast MR has proven of little use in detecting leptomeningeal disease and should be avoided in these patients. CT as well can easily miss disease, and normal contrast-enhanced CT scan does not exclude the presence of leptomeningeal tumor. The ordering physician must be aware that a normal MR or CT study does not exclude LC and that the combination of contrast MR and serial lumbar punctures has the best diagnostic potential.
  • Radiologists often are asked to place the needle into the lumbar thecal sac prior to intrathecal chemotherapy administration. Confirmation of correct needle placement using intrathecal iodinated contrast is important, as an epidural or split injection results in a poor clinical outcome.
 


More on Leptomeningeal Carcinomatosis

Overview: Leptomeningeal Carcinomatosis
Imaging: Leptomeningeal Carcinomatosis
Follow-up: Leptomeningeal Carcinomatosis
Multimedia: Leptomeningeal Carcinomatosis
References
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References

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Further Reading

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Keywords

leptomeningeal carcinomatosis, leptomeningeal metastases, arachnoid metastases, zuckerguss, LC

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Contributor Information and Disclosures

Author

Andrew L Wagner, MD, Assistant Professor of Radiology, Instructional Faculty, University of Virginia School of Medicine; Director of Neuroradiology, Department of Radiology, Rockingham Memorial Hospital
Andrew L Wagner, MD is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, American Society of Neuroradiology, and Radiological Society of North America
Disclosure: Nothing to disclose.

Medical Editor

Lucien M Levy, MD, PhD, Director of Neuroradiology, Professor of Radiology, Department of Radiology, George Washington University Medical Center
Lucien M Levy, MD, PhD is a member of the following medical societies: American Cancer Society, American College of Radiology, American Heart Association, American Medical Association, American Roentgen Ray Society, American Society of Neuroradiology, and Radiological Society of North America
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Val Runge, MD, Robert and Alma Moreton Centennial Chair in Radiology, Professor, Editor-in-Chief of Investigative Radiology, Department of Radiology, Scott and White Clinic and Hospital
Val Runge, MD is a member of the following medical societies: Society for Health and Human Values
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

James G Smirniotopoulos, MD, Professor of Radiology, Neurology, and Biomedical Informatics, Chairman, Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences
James G Smirniotopoulos, MD is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, American Society of Head and Neck Radiology, American Society of Neuroradiology, American Society of Pediatric Neuroradiology, Association of University Radiologists, and Radiological Society of North America
Disclosure: Nothing to disclose.

 
 
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