Images below require Macromedia's Flash Player to view

Neuroradiology Case of the Week

Case 340

August 2008

Hisao Nakamura, MD

Clinical Presentation: Patient is a 20-year-old male with a history of falls and back pain and numbness. He is status bone marrow transplant for AML.

Imaging Findings: Bilateral L5 and bilateral S1 (right more than left) nerve roots are thickened and show enhancement as they come out of neural foraminas (Fig.1 arrows indicate L5 level, Fig. 2 arrows indicate S1 level). There is a soft tissue signal intensity mass lesion in the right paravertebral region at C7-T1, T1-2, T2-3 levels (Fig. 3 is T1-2 level).

Diagnosis: Leptomeningeal involvement of leukemia

Discussion: The leukemias are a heterogeneous group of hematological malignancies resulting from a neoplastic proliferation of hematopoietic cells at an undifferentiated of partially differentiated stage of maturation. Involvement at sites other than the hematopoietic organs and skeleton is uncommon at presentation of pediatric leukemia or lymphoma. Nevertheless, the so-called sanctuary sites (CNS, testes, and kidneys) are affected in 50% of children who experience a relapse after therapy, even during bone marrow remission. Leukemic or lymphomatous cells can involve bone marrow, dura, leptomeniges, or all three. The imaging findings of leptomeningeal involvement is abnormal nodular enhancement in the subarachnoid space, enhancement and thickening of nerve roots, or abnormal enhancement along the pial surface.

References:

1. Vázquez E, Lucaya J, Castellote A, Piqueras J, Sainz P, Olivé T, Sánchez-Toledo J, Ortega JJ. Neuroimaging in pediatric leukemia and lymphoma: differential diagnosis. Radiographics. 2002 Nov-Dec;22(6):1411-28. [PubMed]
2. Ginsberg LE, Leeds NE. Neuroradiology of leukemia. AJR Am J Roentgenol. 1995 Sep;165(3):525-34. [PubMed]