Neuroimaging studies are extremely useful in defining the extent of leptomeningeal disease in children who have underlying primary CNS or solid tumors. Neuroimaging studies also facilitate the identification of areas of bulky disease and the assessment of CSF flow dynamics. In children with CNS leukemia, neuroimaging studies of the brain and/or spinal cord are sometimes obtained if there are focal neurological symptoms (e.g. cranial nerve palsies, visual problems, or localized pain). Furthermore, it is not unreasonable to obtain a baseline head MRI at the initial diagnosis of CNS leukemia or lymphoma.
As with CSF cytology, negative imaging studies do not preclude a diagnosis of leptomeningeal metastases. It has been suggested that if there is a strong clinical suspicion of neoplastic meningitis in the presence of negative cytology and neuroimaging studies, that obtaining a high-dose gadolinium-enhanced MRI may increase the diagnostic yield.18
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