Related Experiment Video
Updated: Jul 10, 2026
Murine Model of Leukemia Relapse to Induction Chemotherapy for Acute Lymphoblastic Leukemia
Published on: October 17, 2025
MRI diagnosis of bone marrow relapse in children with ALL
J Herman Kan1, Marta Hernanz-Schulman, Haydar A Frangoul
1Department of Radiology and Radiological Sciences, Vanderbilt Children's Hospital, Vanderbilt University, 2200 Children's Way, Nashville, TN 37232, USA. herman.kan@vanderbilt.edu
Background:
Diffuse marrow replacement in acute leukemia is well known, but there are few reports describing the MRI features of pediatric leukemic relapse.
Objective:
Our purpose was to describe the MRI appearance of pediatric leukemic relapse.
Materials And Methods:
A total of 53 consecutive children with a history of ALL were referred for musculoskeletal MRI from 1 January 1998 to 28 February 2007 at one center, and from 1 January 2000 to 2 May 2007 at a second center. From this group, 14 children seen at initial diagnosis of leukemia and 2 children who underwent MRI after therapy for relapse were excluded. The remaining 37 children, 8 with relapse and 29 in remission, were studied. Images of patients with relapse and in remission were reviewed for type and configuration of marrow infiltration; coexisting marrow alterations including osteonecrosis or stress reaction were also reviewed.
Results:
All eight children with relapse demonstrated nodular lesions with well-defined margins. Coexisting osteonecrosis was present in three children (38%) and pathologic fracture in one. Among the 29 children in remission, 9 showed stress reaction/fracture, 14 showed osteonecrosis and 9 showed ill-defined nodules, and in 5 the marrow was completely normal.
Conclusion:
Well-defined nodules in all patients with leukemic relapse suggest that this appearance is characteristic and distinct from the published findings of diffuse marrow replacement in acute leukemia.
Insights
Pediatric leukemic relapse shows distinct MRI features, characterized by well-defined nodules. This finding differs from diffuse marrow replacement seen in acute leukemia, aiding in diagnosis.
Area of Science:
- Pediatric Radiology
- Oncology Imaging
Background:
- Diffuse marrow replacement is a known feature of acute leukemia.
- Limited reports exist on MRI findings of pediatric leukemic relapse.
Purpose of the Study:
- To describe the characteristic MRI appearance of pediatric leukemic relapse.
- To differentiate relapse imaging findings from other marrow abnormalities.
Main Methods:
- Retrospective review of musculoskeletal MRI scans from 37 children with a history of acute lymphoblastic leukemia (ALL).
- Analysis of 8 children with confirmed relapse and 29 in remission.
- Evaluation of marrow infiltration patterns and coexisting bone abnormalities.
Main Results:
- All 8 children with relapse exhibited nodular lesions with well-defined margins.
- Osteonecrosis was present in 38% of relapsed patients; one had a pathologic fracture.
- Children in remission showed varied findings including stress reactions, osteonecrosis, and ill-defined nodules.
Conclusions:
- Well-defined nodules on MRI are characteristic of pediatric leukemic relapse.
- This distinct appearance differentiates relapse from diffuse marrow replacement in acute leukemia.
- MRI findings aid in the accurate diagnosis of pediatric leukemic relapse.
More Related Videos
Related Concept Videos
01:22Bone Marrow Sampling and Transplants
The transplant begins with high doses of chemotherapy and radiation treatment, which aim to destroy the...
01:24Magnetic Resonance Imaging