The role of magnetic resonance imaging in the diagnosis of central nervous system involvement in children with acute lymphoblastic leukemia

Lauer, Monika; Kernen, Elisabeth; Schwabe, Dirk; Lehrnbecher, Thomas; Porto, Luciana

doi:10.1002/pbc.28294

Cited by 6 publications

(6 citation statements)

References 12 publications

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“…In particular, cases with NM tended to be older. This is consistent with literature reports [ 4 , 24 , 25 ]. Age, but not sex, significantly associated with NM, where the group within the range of 6 to 12 years old was more affected.…”

Section: Discussionsupporting

confidence: 94%

“…Conversely, this NM is within the first places in other reports [ 35 ]. In this study, PRES may had been underdiagnosed because all children had a head CT scan but not all had Magnetic Resonance Imaging (MRI), which depended on the medical criteria of each assigned physician, which was different from the recommended MRI for all children with leukemia showing NM [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

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Neurological Involvement in Pediatric Patients with Acute Leukemia: A Retrospective Cohort

et al. 2022

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Acute leukemia (AL) is an important cause of morbidity and mortality in children, and neurological manifestations (NM) are frequent. The objective of this study was to analyze neurological manifestations in children with acute leukemia from cases attended in the last five years at the Centro Médico Nacional “20 de Noviembre”. Methods: Conducting a retrospective and analytical study from 1 January 2015 to 31 December 2020 in children with AL classified according to sex, age range and AL type. Participants were grouped according the presence of NM. Results: We analyzed 607 patients: 54.85% boys and 44.14% girls, with a mean age of 7.27 ± 4.54 years. When comparing groups, the NM group was significantly older (p = 0.01), and the highest prevalence was between 6 and 12 years old. ALL was predominant over the other lineages (p ≤ 0.01). The most frequent NM was CNS infiltration, seizures, headache and neuropathy. Death outcomes occurred in 18.7% of children with AML, 11.8% with ALL and 50% with MPAL (p ≤ 0.002). The NM group was associated with higher mortality during a follow-up time of 77.9 ± 49 months (44.4% vs. 8.9% deaths, NM vs. non-NM, respectively; OR = 3.3; 95% CI 2.4 to 4.6; p ≤ 0.0001). Conclusions: ALL was the most prevalent leukemia type. CNS infiltration, seizures, headache, neuropathy and PRES were the most frequent symptoms in the NM group. NM was associated with a higher mortality rate.

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Section: Discussionsupporting

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Neurological Involvement in Pediatric Patients with Acute Leukemia: A Retrospective Cohort

et al. 2022

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“…The diagnosis of AL of the CNS in human medicine requires a combination of clinical signs, CSF cytospin, +/− flow cytometry, +/− MRI, and specific cases of meningeal/tissue biopsy ( 24 , 27 , 29 , 30 , 32 ). A focal or diffuse nodular leptomeningeal enhancement and enlargement of the cranial nerves on MRI are considered indicative of CNS involvement and warrant local treatment ( 33 , 34 ). Pachymeningeal enhancement at two or more sites in the brain is a negative prognostic factor ( 28 ).…”

Section: Discussionmentioning

confidence: 99%

“…The MRI scan is of particular relevance in patients with AL and normal CSF analysis but with a high clinical suspicion of CNS involvement ( 33 ). Historically, the diagnosis of leukemia of the CNS relied mainly on the cytospin of the CSF.…”

Section: Discussionmentioning

confidence: 99%

Neurological manifestations in dogs with acute leukemia

Lyseight,

Pittaway,

Dennis

et al. 2024

Front. Vet. Sci.

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Canine acute leukemia is a rare hematopoietic neoplasm. Neurological abnormalities have been frequently reported in dogs with acute leukemia (AL). However, the description of the presentation and findings are limited. This study aimed to describe the clinical findings in dogs with acute leukemia presenting with neurological signs as their primary complaint. The database of a private referral hospital was searched for cases that presented to the neurological department with neurological deficits and were subsequently diagnosed with acute leukemia. Six cases were included; all had neurological clinical signs and an abnormal neurological examination. All cases had a focal neuroanatomical localisation on neurological examination (brain n = 4; spinal = 2). Out of the four dogs with a complete magnetic resonance imaging (MRI) study, there was an ill-defined infiltrative pattern with abnormal signal intensity in the central nervous system (CNS) in three dogs and the loss of grey and white matter differentiation in the brain (n = 2) and/or spinal cord (n = 2). Other MRI findings included abnormal meningeal enhancement (n = 3), changes affecting spinal nerves and epaxial muscles (n = 2), and lymphadenopathy in the field of view (n = 2). The bone marrow assessment on MRI showed evidence of signal change (n = 3), characterized by a loss of normal fat opacity and an abnormal degree of contrast enhancement. The cerebrospinal fluid (CSF) analysis of the four dogs showed an increased protein level with non-specific pleocytosis and without evidence of malignant cells. Treatment with cytotoxic medication was implemented in two dogs. The dogs diagnosed with acute leukemia had focal neuroanatomical localisation, an infiltrative CNS pattern, and bone marrow remodulation on MRI with an increase in CSF protein and negative cytology analysis.

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“…Recently, we have reported that routine MRI examination as initial work-up does not add any information regarding treatment of children with ALL nor does it improve the detection of CNS involvement compared with CSF analysis alone. These data resulted in a change of our internal standard [ 17 ]. Similarly, our present data demonstrate that EEG findings during initial work-up are not helpful in predicting neurological complications during therapy for ALL.…”

Section: Discussionmentioning

confidence: 99%

No role for electroencephalogram in the initial work-up of pediatric acute lymphoblastic leukemia

Barnbrock

Lüsebrink

Schubert‐Bast

et al. 2023

Support Care Cancer

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Purpose The purpose of this study was to verify whether there is a prognostic benefit of electroencephalogram (EEG) performed during initial work-up of children with newly diagnosed acute lymphoblastic leukemia (ALL). Methods In this retrospective monocenter study, we analyzed the value of electroencephalogram (EEG) performed during initial work-up of children with newly diagnosed acute lymphoblastic leukemia (ALL). All pediatric patients were included in this study who were diagnosed with de novo ALL in our institution between January 1, 2005, and December 31, 2018, and in whom an EEG was performed for initial work-up within 30 days of diagnosis of ALL. EEG findings were associated with the occurrence and the etiology of neurologic complications occurring during intensive chemotherapy. Results Out of 242 children, EEG revealed pathological findings in 6 patients. Two of them developed a seizure at a later time point due to adverse effects of chemotherapy, whereas 4 children had an uneventful clinical course. In contrast, 18 patients with normal initial EEG findings developed seizures during therapy for different reasons. Conclusion We conclude that routine EEG does not predict seizure susceptibility in children with newly diagnosed ALL and is unnecessary in the initial work-up as EEG investigation in young and often sick children requires sleep deprivation and/or sedation, and our data demonstrate no benefit in predicting neurological complications.

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The role of magnetic resonance imaging in the diagnosis of central nervous system involvement in children with acute lymphoblastic leukemia

Cited by 6 publications

References 12 publications

Neurological Involvement in Pediatric Patients with Acute Leukemia: A Retrospective Cohort

Neurological Involvement in Pediatric Patients with Acute Leukemia: A Retrospective Cohort

Neurological manifestations in dogs with acute leukemia

No role for electroencephalogram in the initial work-up of pediatric acute lymphoblastic leukemia

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