Investigation of choice for meningial carcinamatosis?
A. Non contrast CT
B. Contrast MRI
Correct answer : B. Contrast MRI
Ref: Harrison, 18th ed
Leptomeningeal metastases are particularly challenging to diagnose as identification of tumor cells in the subarachnoid compartment may be elusive. MR imaging can be definitive in patients when there are clear tumor nodules adherent to the cauda equina or spinal cord, enhancing cranial nerves, or subarachnoid enhancement on brain imaging. Imaging is diagnostic in approximately 75% of patients and is more often positive in patients with solid tumors.
(An image given with the above paragraph in Harrison shows Postgadolinium MRI images of extensive leptomeningeal metastases from breast cancer.)