Role of CT & MRI in the Imaging Spectrum of Central Nervous System Complications in Paediatric Leukemias
Journal of Medical Science And clinical Research
Leukemia is the most common childhood malignancy representing nearly 30% of all malignancies in children. With advances in treatment, prognosis and survival rates have vastly increased, resulting in a similar increase in the number of adverse effects and complications as well. There is an increased risk of CNS complications in acute leukemia either resulting from direct effects of leukemia or from antileukemic therapy. Bone marrow transplantation requires suppression of the recipient's immune
... ecipient's immune system and administration of cytotoxic drugs like cyclophosphamide. Early recognition of CNS complications is important, in order to ensure timely treatment and to avoid grave consequences, thereby improving the overall survival benefits. Most of the neurologic complications have similar overlapping clinical presentations resulting in a diagnostic dilemma. Here imaging, especially CT & MRI has a major role to play and helps to arrive at a reasonable diagnosis. This study retrospectively analyzed neuroimaging of 149 pediatric leukemic patients who underwent CT/MRI with a clinical suspicion of neurological complication. Of the 149 children, CT brain was done for 90 children, MRI brain was done for 40 children and 10 of them had both CT and MRI done. Positive findings were recorded in 44 children on CT and 24 children on MRI. The diverse pathologic entities that we came across in CT/MRI of these patients have been grouped into different categories. The major complications encountered were cerebrovascular complications including venous sinus thrombosis, intracranial haemorrhages and infarcts, CNS infections, leukaemic involvement, misclellaneous conditions like hydrocephalous and treatment complications. These included mainly, leukoencephalopathy, methotrexate related complications and PRES.