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Objective The cerebrospinal fluid (CSF) cytological and imaging features in 4 patients with meningeal carcinomatosis (MC) were investigated to assist with the diagnosis and improve the treatment of the disease. Methods A retrospective analysis was utilized to investigate the clinical manifestations, imaging, and liquid⁃based CSF cytology of 4 patients with MC by using CSF cytology, all of whom were treated at the Department of Neurology at Wuhan No.1 Hospital from February 2016 to January 2019. Results Four patients (2 males and 2 females) with an average age of (60.00±15.85) years old had a symptom ofheadache,2 of whom had a symptom of slow response. Among 4 patients, all had a history of tumor disease; 2 had a history of lung cancer; one had a history of gastric cancer; one had a history of breast cancer. Four patients underwent lumbar puncture. Two patients had increased white blood cell count, and the other 2 demonstrated decreased glucose levels. Three patients had elevated protein levels. There were 3 cases with increased intracranial pressure (ICP) and 4 cases with atypical cells, as indicated byliquid⁃based CSF cytology. However, no apparent meningeal enhancement was found in 4 patients. One of the patients had a negative PET⁃CT. All patients had been receiving or received symptomatic treatment during hospitalization. Post hospital discharge, one patient had been in treatment, and the other 3 patients died within one month to one year after diagnosis. Conclusions The imaging findings of patients with MC were atypical. The clinical history of patients with MC can help with diagnosis. The CSF cytology on these patients has considerable significance to diagnosis. DOI：10.3969/j.issn.1672⁃6731.2020.07.015