Neuroimaging in Pediatric Leukemia and Lymphoma: Differential Diagnosis

Elida Vázquez, MD ; Javier Lucaya, MD ; Amparo Castellote, MD ; Joaquim Piqueras, MD ; Pilar Sainz, MD ; Teresa Olivé, MD ; José Sánchez-Toledo, MD ; Juan J. Ortega, MD

1 From the Department of Pediatric Radiology and Institut de Diagnòstic per la Imatge (E.V., J.L., A.C., J.P., P.S.), Department of Pediatric Hematology (T.O., J.J.O.), and Department of Pediatric Oncology (J.S.T.), Hospital Vall d’Hebron, Ps Vall d’Hebron 119–129, 08035 Barcelona, Spain. Presented as an education exhibit at the 2001 RSNA scientific assembly. Received February 18, 2002; revision requested April 26 and received June 13; accepted June 14.

Recent advances in therapy for pediatric hematologic neoplasms have greatly improved the prognosis but have resulted in an increased incidence of associated complications and toxic effects. The main neuroimaging features in pediatric patients with leukemia or lymphoma treated with chemotherapy or radiation therapy were retrospectively reviewed. To simplify the approach and facilitate differential diagnosis, the neuroimaging features have been classified into three main categories: central nervous system manifestations of primary disease, side effects of therapeutic procedures (radiation therapy, chemotherapy, bone marrow transplantation), and complications due to immunosuppression, particularly infections. Manifestations of primary disease include cerebrovascular complications (hemorrhage, cerebral infarction) and central nervous system involvement (infiltration of the meninges, parenchyma, bone marrow, orbit, and spine). Effects of radiation therapy include white matter disease, mineralizing microangiopathy, parenchymal brain volume loss, radiation-induced cryptic vascular malformations, and second neoplasms. Effects of chemotherapy and bone marrow transplantation include hemorrhage, dural venous thrombosis, white matter disease, reversible posterior leukoencephalopathy syndrome, and anterior lumbosacral radiculopathy. Both the underlying malignancy and antineoplastic therapy can cause immunosuppression. Fungi are the most frequent causal microorganisms in immunosuppressed patients with infection. Familiarity with the imaging findings is essential for proper diagnosis of neurologic symptoms in pediatric patients with oncohematologic disease.