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Abnormal computed tomography brain scans in children with acute lymphoblastic leukemia: serial long-term follow-up
Insights
Long-term follow-up CT scans reveal that intracerebral calcifications (CALs) can develop years after treatment for childhood acute lymphoblastic leukemia (ALL). This suggests continued neuroimaging surveillance is crucial for these patients.
Area of Science:
- Pediatric Oncology
- Neuroradiology
- Neuroscience
Background:
- Previous studies identified CT scan abnormalities in asymptomatic children treated for acute lymphoblastic leukemia (ALL).
- Abnormalities included ventricular dilatation, subarachnoid space dilatation, decreased attenuation, and calcifications.
Purpose of the Study:
- To investigate the natural history of CT scan abnormalities in children treated for ALL.
- To determine the long-term evolution of brain imaging findings after prophylactic cranial irradiation and intrathecal chemotherapy.
Main Methods:
- Serial CT scans were performed on 24 children for at least seven years post-treatment initiation.
- Analysis focused on changes in ventricular dilatation, subarachnoid space dilatation, decreased attenuation, and calcifications.
Main Results:
- Ventricular and subarachnoid space dilatations remained stable.
- Decreased attenuation areas resolved in follow-up scans.
- Intracerebral calcifications developed in five patients 5-7 years after treatment, primarily in those diagnosed before age 8.
Conclusions:
- Intracerebral calcifications can manifest years after cessation of CNS-directed therapy for ALL.
- Long-term CT scan follow-up is recommended for children who received prophylactic CNS therapy.
Abstract:
In a previous study we reported the occurrence of computed tomographic (CT) brain-scan abnormalities in a group of asymptomatic children with acute lymphoblastic leukemia (ALL) who had received prophylactic cranial irradiation and maintenance intrathecal chemotherapy. One or more of four types of CT-scan abnormalities were observed: ventricular dilatation (VD), subarachnoid space dilatation (SAD), areas of parenchymal decreased attenuation coefficient (DAC), and intracerebral calcifications (CALs). To study the natural history of these findings, serial CT scans were obtained on 24 of the original 32 patients who were available for long-term follow-up. CT scanning was performed for a minimum of seven years from the initiation of CNS preventive therapy. Review of the CT scans showed that VD (n = 5) and SAD (n = 7) were stable over the time of follow-up. DAC, originally observed in two patients, was no longer present on follow-up scans. In contrast, five patients developed CALS from five to seven years after initiation of CNS preventive therapy. All occurred in children who were less than 8 years of age at the time of diagnosis (P less than .01). These data indicate that CALs may develop many years after the cessation of CNS preventive therapy and suggest that long-term CT-scan follow-up should be considered in children who have received CNS preventive therapy.