L-asparaginase therapy with concomitant cranial venous thrombosis: can MRI help avoiding stroke
1The Department of Radiology, National Cancer Institute, Cairo University.
Purpose:
To prospectively use MRI in the early detection of intracranial sino-venous thrombosis during the L-asparaginase induction therapy of acute leukemia thus preventing the evolution of brain venous infarct.
Material And Methods:
The study population consisted of seventy patients receiving L-asparaginase induction therapy for acute leukemia in the National Cancer Institute of Cairo University presenting with clinical neurological signs suggestive of aseptic intracranial venous thrombosis. All the patients were studied by 1.5 Tesla magnet using conventional MRI pulse sequences and MR venographic studies. The imaging findings were processed as regards the detection of venous thrombosis, its signal criteria and the evaluation of any companion brain parenchymal ischemic insults.
Results:
Eleven patients were diagnosed with dural venous sinus thrombosis with subsequent specific signal pattern of the thrombus that could be linked to the duration of thrombosis. The MR venographic studies detected the thrombosis in nine cases out of eleven. Ten cases scored brain parenchymal signal abnormality that could indicate infarction, eight of them were hemorrhagic in nature.
Conclusion:
L-asparaginase therapy is accompanied by high risk of venous thrombosis that could involve the intra-cranial sino-venous structures. MRI could be used effectively in the early diagnosis of such serious, curable complication using a combination of conventional spin echo pulse sequences and MR venographic studies. Hemorrhagic venous infarcts should draw the attention to underlying established venous thrombosis.
Key Words:
Asparaginase - Venous thrombosis-MRI.
Insights
Magnetic Resonance Imaging (MRI) effectively detects intracranial sino-venous thrombosis, a complication of L-asparaginase therapy in acute leukemia patients, preventing brain venous infarcts.
Area of Science:
- Neurology
- Radiology
- Hematology
Background:
- L-asparaginase therapy for acute leukemia carries a risk of venous thrombosis.
- Intracranial sino-venous thrombosis is a serious complication.
- Early detection is crucial to prevent neurological damage.
Purpose of the Study:
- To prospectively evaluate MRI for early detection of intracranial sino-venous thrombosis.
- To identify MRI findings indicative of thrombosis during L-asparaginase therapy.
- To prevent the progression to brain venous infarcts.
Main Methods:
- Seventy acute leukemia patients receiving L-asparaginase induction therapy were studied.
- Conventional MRI sequences and MR venography were utilized.
- Imaging focused on detecting venous thrombosis and associated ischemic changes.
Main Results:
- Eleven patients (15.7%) were diagnosed with dural venous sinus thrombosis.
- Specific thrombus signal patterns correlated with thrombosis duration.
- MRI detected thrombosis in 9/11 cases; 10 cases showed parenchymal abnormalities, 8 hemorrhagic.
Conclusions:
- L-asparaginase therapy is associated with a significant risk of intracranial venous thrombosis.
- MRI, combining conventional sequences and MR venography, is effective for early diagnosis.
- Hemorrhagic venous infarcts suggest underlying established venous thrombosis.
Related Concept Videos
01:29Venous Thrombosis III: Interprofessional Care
01:30Venous Thrombosis IV: Nursing Management
01:21Imaging Studies for Cardiovascular System IV: CMRI
01:22Aneurysm IV: Nursing Management
01:20Venous Thrombosis II: Clinical Manifestations and Diagnostic Studies
01:14Imaging Studies I: CT and MRI
Description of the Procedures
Computed Tomography (CT) scan:
Computed Tomography (CT) scans use X-ray technology to generate detailed images of bones, organs, and tissues. During the scan, the patient lies on a moving table...