Diffusion-MR imaging usefulness in the differential diagnosis of acute leukoencephalopathy in children during treatment of haematological malignancies

Congress:

ECR 2006

Poster Number:

C-640

Type:

Educational

Keywords:

Authors:

E. Marco de Lucas, K. González Mandly, S. Sánchez, S. Gutiérrez, C. Díez, M. Pelaz, G. Blanco, R. Pellón, J. Jordá; Santander/ES

DOI:

DOI-Link:

https://dx.doi.org/

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Fig. 4: Diameter reduction of treated PV as seen on MRI.

Fig. 5: MRI angiography of PV. Left lower PV before RFCA (a). One day after RFCA...

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Learning objectives

1) To show the MRI findings, including DWI and ADC maps, in patients with acute methotrexate neurotoxicity. 2) To analyze the differential diagnosis based on DWI and ADC findings of patients with acute neurological treatment-related complications during treatment of haematologic malignancies.

Background

1. Possible causes of acute neurological deterioration in children during treatment of haematological malignancies (especially, Acute Lymphoblastic Leukemia-ALL-) : cerebrovascular disease (arterial or venous thrombosis) CNS invasion by neoplastic cells CNS infection metabolic or electrolytic disturbances drug neurotoxicity - Clinical findings in these patients are not sufficient specific to establish an accurate diagnosis. In addition, quite different treatment guidelines are used for each of these entities. In order of history, clinical, biological and imaging findings, neoplastic, infectious, metabolic and vascular diseases may be excluded. -...

Imaging findings OR Procedure details

We reviewed the clinical and neuroimaging findings of seven patients presented at our institution with white matter hyperintensities and neurologic complications during treatment of hematologic malignancies. The studies were performed on a 1.5 T MR unit of our hospital. We reviewed the clinical and radiologic findings of seven patients methotrextae related neurotoxicity during or after treatment with intrathecal methotrexate. Acute methotrexate neurotoxicity imaging findings CT: has a minor role because of its lower sensitivity to detect white matter lesions. Usually normal at first diagnostic episode...

Conclusion

Include always a diffusion sequence in your MR studies of patients with a possible leukoencephalopathy! (if you don't use it in all of your patients) Acute methotrexate neurotoxicity is a rare transient encephalopathy encountered after 1 week of MTX medication, resolving spontaneously within few days. DWI and ADC allow a more confident recognition and differential diagnosis in patients with suspected acute methotrexate neurotoxicity, because identifies areas of white matter injury before lesions are detectable with other standard sequences. Restricted diffusion does not mean necessarily permanent...

References

1. Sandoval C, et al. Neurotoxicity of intrathecal methotrexate: MR imaging findings. AJNR Am J Neuroradiol 2003;24:1887-90. 2. Buonanno F, et al. Posterior leukoencephalopathy without severe hypertension: utility of diffusion-weighted MRI. Neurology 1998; 51(5):1369-1376. 3. Fischer MJ, et al. Diffusion-weighted MR imaging of early methotrexate-related neurotoxicity in children. AJNR Am J Neuroradiol 2005:1686-1689. 4. Rollins N, et al. Acute methotrexate neurotoxicity: findings on diffusion-weighted imaging and correlation with clinical outcome. AJNR Am J Neuroradiol 2004; 25:1688-95. 5. Ziereisen F, et al. Reversible acute methotrexate leukoencephalopathy:...

Personal Information

This presentation has been prepared from the Neuroradiology section (including staff and residents) of the Radiology Department of Valdecilla Universitary Hospital, in Santander, Spain We thank collaboration from our colleagues of Neurology, Hematology Departments; and our radiographers from the MR unit ( José, Cristina, Carlos, Ana, Yolanda, Bernardo, Raquel, ...) Contact: Enrique Marco de Lucas, Departamento de Radiodiagnóstico, Hospital Universitario Maqués de Valdecilla, Av. Valdecilla s/n, 39008, Santander, Cantabria, Spain. email: [email protected]