Neuroimaging in Pediatric Leukemia and Lymphoma: Differential Diagnosis

Abstract

Recent advances in therapy for pediatric hematologic neoplasms have greatly improved the prognosis but have resulted in an increased incidence of associated complications and toxic effects. The main neuroimaging features in pediatric patients with leukemia or lymphoma treated with chemotherapy or radiation therapy were retrospectively reviewed. To simplify the approach and facilitate differential diagnosis, the neuroimaging features have been classified into three main categories: central nervous system manifestations of primary disease, side effects of therapeutic procedures (radiation therapy, chemotherapy, bone marrow transplantation), and complications due to immunosuppression, particularly infections. Manifestations of primary disease include cerebrovascular complications (hemorrhage, cerebral infarction) and central nervous system involvement (infiltration of the meninges, parenchyma, bone marrow, orbit, and spine). Effects of radiation therapy include white matter disease, mineralizing microangiopathy, parenchymal brain volume loss, radiation-induced cryptic vascular malformations, and second neoplasms. Effects of chemotherapy and bone marrow transplantation include hemorrhage, dural venous thrombosis, white matter disease, reversible posterior leukoencephalopathy syndrome, and anterior lumbosacral radiculopathy. Both the underlying malignancy and antineoplastic therapy can cause immunosuppression. Fungi are the most frequent causal microorganisms in immunosuppressed patients with infection. Familiarity with the imaging findings is essential for proper diagnosis of neurologic symptoms in pediatric patients with oncohematologic disease.

Brain MR imaging abnormalities in pediatric patients after allogeneic bone marrow transplantation

“…In our study 1 case (3.03%) complained of headache on day 5 post transplant, and MRV showed thrombosis of the superior sagittal sinus, which recanalized in the follow up studies. For the diagnosis of venous thrombosis, the combination of MR imaging with MRV is now the method of choice because of its capability to reveal a lack of flow in the cerebral veins even with the absence of typical findings of brain infarcts (18). Whereas the thrombus is easily recognizable in the subacute phase, it can be mistaken for flowing blood in the acute phase, but MRV will demonstrate the absence of flow (10).…”

Correlating Pathology With the Clinical Symptoms of Methotrexate-induced Leukoencephalopathy in a Child With Relapsed T-cell Acute Lymphoblastic Leukemia

“…12 Ring-enhancing lesions are common MRI findings in CNS infection but are not seen in MTX-induced leukoencephalopathy. 13 Our pathologic and radiologic findings suggest that MTX-induced leukoencephalopathy can produce a broader range of MRI findings than previously described. CNS relapse occurs in 3% to 8% of children with ALL.…”

Cerebellar Mass as a Location of Acute Lymphoblastic Leukaemia

“…Although rare, intracranial masses may occur in the course of leukaemia. Granulocytic sarcoma (chloroma) is a mass composed of primitive precursors of the granulocytic cells, which include myeloblasts, promyelocytes and myelocytes 2 . Chloroma mainly affects patients with myelogenous leukaemia but it may appear also in patients with other myeloproliferative disorders most commonly involving bone, periosteum, soft tissue, lymph nodes, and skin, although it can occur anywhere throughout the body 1,5 .…”