Type:
Educational Exhibit
Keywords:
Neuroradiology brain, Haematologic, Oncology, CT, MR, Education, Treatment effects, Radiation therapy / Oncology, Haematologic diseases, Leukaemia
Authors:
I. G. Lupescu, I. C. Lupescu, A. E. Ghergus, A. C. Nicolae, G. Popa; BUCHAREST/RO
DOI:
10.1594/ecr2012/C-2548
Background
INTRODUCTION. Leukemias are a heterogeneous group of hematologic malignancies resulting from a neoplastic proliferation of hematopoietic cells at an undifferentiated or partially differentiated stage of maturation.
Patients with acute leukemias (AL),
have an increased risk of developing disease of the central nervous system (CNS) or head and neck.
The WHO classification of the AL incorporates morphologic,
immunophenotypic,
genetic,
and clinical features in an attempt to classify these entities.
The AL are classified as myeloid or lymphoid on the lineage of the blast cells [1].
INCIDENCE. The overall incidence of acute leukemia is approximately 4/100000 population per year,
with 70% of these cases being acute myeloid leukemia (AML).
Acute lymphoblastic leukemia (ALL) is predominantly a disease of children,
75% of cases usually under 6 years.
Acute leukemia comprises approximately 1/3 of cases of childhood cancer.
The majority of AML cases occur in adults,
median age under 60 years with an incidence of 10/100000 population/year in individuals 60 years and older [2,3].
ETIOLOGY.
The possible etiologic factors associated with the leukemias and myelodysplastic syndromes (MDS) include viruses,
ionizing radiation,
cytotoxic chemotherapy and benzene [1].
COMPLICATIONS OF AL.
Approximately 25-50% of patients with AL will suffer a central nervous system (CNS) complication at some point in the course of the disease [3-9].
The cranio-cerebral complications of AL can be divided into those that result directly or indirectly from the acute leukemic diseases and those that can be attributed to antileukemic therapy related to the neurotoxicity of the chemotherapeutic drugs,
radiation therapy,
bone marrow transplantation,
and immunosuppression [4-7].
Certain complications are most likely due to multiple underlying causes [4-6,
9,
45-46].
In AL patients,
with acute and progressive neurologic signs and symptoms,
the differential diagnosis includes:
- direct spread to the cranio-cerebral region of the leukemic cells
- cerebro-vascular complications,
- infectious,
and
- treatment-related complications [4-6].
More than one type of lesion may coexist (Fig. 1).
IMAGING. Knowledge of the CNS leukemic complications spectrum and their imaging findings (computer tomography and magnetic resonance imaging) is necessary to achieve a correct diagnosis in the leukemic patients who presents neurologic signs and symptoms [4-9].