Prognostic Utility of Neuraxis Imaging in Leptomeningeal Metastasis: A Retrospective Case Series

Objective: Correlate imaging and survival in a retrospective series of patients with leptomeningeal metastasis (LM). Methods: 240 patients with LM (125 solid tumour patients with positive CSF cytology; 40 solid tumour patients with negative CSF cytology and MRI consistent with LM; 50 lymphoma and 25 leukaemia patients with positive CSF flow cytometry), all considered for treatment, underwent prior to treatment neuraxis MRI and radio-isotope CSF flow studies. Results: Survival was significantly shortened in patients with large volume MRI-defined disease and in patients with CSF flow obstruction irrespective of primary tumour histology. Additionally, cause of death differed wherein patients with large volume of disease or obstructed CSF flow more often died of progressive LM disease. Conclusions: Neuraxis imaging utilizing brain and spine MRI as well as radio-isotope CSF flow studies has prognostic significance and is predictive of median overall survival in this large cohort of patients all considered for treatment with LM.