Detecting meningeal carcinomatosis from breast cancer with thallium-201 SPECT

How to facilitate early diagnosis of CNS involvement in malignant lymphoma

INTRODUCTION

Making the diagnosis of secondary CNS involvement in lymphoma can be difficult due to unspecific signs and symptoms, limited accessibility of brain/myelon parenchyma and low sensitivity and/or specifity of imaging and cerebrospinal fluid (CSF) examination currently available. Areas covered: MRI of the total neuroaxis followed by CSF cytomorphology and flow cytometry are methods of choice when CNS lymphoma (CNSL) is suspected. To reduce the numerous pitfalls of these examinations several aspects should be considered. New CSF biomarkers might be of potential diagnostic value. Attempts to standardize response criteria are presented. Expert commentary: Diagnosing CNSL remains challenging. Until diagnostic methods combining high sensitivity with high specifity are routinely introduced, high level of awareness and optimal utilization of examinations currently available are needed to early diagnose this potentially devastating disease.

Detection of neoplastic meningitis in a patient with gastric cancer by thallium-201 SPECT

We describe the usefulness of thallium-201 SPECT in a patient with neoplastic meningitis (NM) from gastric carcinoma. Thallium-201 SPECT is of value for the diagnosis of cancer; retention of thallium-201 on delayed images strongly suggests malignancy. NM is a lethal, major neurologic complication of cancer. The standard for the diagnosis of NM is cytologic confirmation of malignant cells in CSF, but cytologic results are often negative (estimated false negative rate, 50%), even when NM is strongly suspected clinically. In patients with equivocal findings, our findings suggest that thallium-201 SPECT is one helpful tool for the detection of NM, particularly when associated with signet-ring cell carcinoma.