Radiological aspects of leukaemia in childhood

Abstract

Absfract. The change in radiological features of leukaemia, treated with modern methods, were studied in a retrospective investigation. Of 108 patients with leukaemia treated between 1964 and 1974 at the Children's Hospital, Heidelberg, 89 were studied. Radiological findings were divided into three groups: (i) alterations due to acute leukaemia in the initial phase (ii) late manifestations of leukaemia and (iii) alterations due to side-effects of antileukaemic therapy.It became apparent that, with prolonged survival, there was an increase in the late manifestations of leukaemia, especially in the central nervous system. This was followed by a decrease after the introduction of the therapeutic regime described by Pinkel. The immunosuppressive effect of this antileukaemic therapy gave rise to life-threatening infections, notably with Pneumocystis carinii. Besides the leukaemic manifestations in bones, kidney, and the viscera of the thorax, there were steroid-induced osteoporosis, platyspondyly and aseptic bone necrosis, and, inflammatory gastrointestinal lesions. In addition, ileus sometimes followed administration of vincristine and toxic-allergic pneumonia after methotrexate therapy occurred.

Aseptic osteonecrosis in children treated for acute lymphoblastic leukemia and aplastic anemia

“…Aseptic bone necrosis is not listed as a primary clinical or radiographic lesion of ALL [2,14,19,20,28], although microscopically it may be seen in untreated leukemia [15]. Four patients on maintenance therapy [3,12] and/or longterm remission of ALL [10] have been reported earlier with aseptic bone necrosis. Since it is not a lesion typical of leukemia, it may be a manifestation of the toxic side effects of intensive antileukemic therapy.…”

Prognostic significance of primary bone changes in children with acute lymphoblastic leukemia

“…However, there has been a surprisingly large variation between the results of different studies [3,5,14]. Nevertheless, in the early 1950's Heikel and Wegelius reported that a 78% incidence of changes in long bones among 93 leukemic children at our hospital [9].…”

Hematologic Bone Diseases

“…Diffuse sclerosis of the bones has been encountered, but it is thought to be secondary myelofibrosis resulting from therapeutic interventions. 8 Infiltration of the meninges of the brain creates a separation of the skull sutures in a small percentage of patients with leukemia. Based on the radiographic findings alone, differentiation of infiltration of the meninges from neuroblastoma metastasis to the skeleton can be challenging because both conditions cause periostitis and separation of the sutures.…”