Role of neuroimaging in children with acute lymphoblastic leukemia and central nervous system involvement at diagnosis

Susanna Ranta; Maarit Palomäki; Mette Levinsen; Mervi Taskinen; Jonas Abrahamsson; Karin Mellgren; Riitta Niinimäki; Kjeld Schmiegelow; Mats Heyman; Arja Harila-Saari; Nordic Society of Pediatric Hematology and Oncology (NOPHO)

doi:10.1002/pbc.26182

Role of neuroimaging in children with acute lymphoblastic leukemia and central nervous system involvement at diagnosis

Susanna Ranta, Maarit Palomäki, Mette Levinsen, Mervi Taskinen, Jonas Abrahamsson, Karin Mellgren, Riitta Niinimäki, Kjeld Schmiegelow, Mats Heyman, Arja Harila-Saari, Nordic Society of Pediatric Hematology and Oncology (NOPHO)

Department of Clinical Medicine

6 Citations (Scopus)

Abstract

BACKGROUND: Each year approximately 200 children and adolescents are diagnosed with acute lymphoblastic leukemia (ALL) in the five Nordic countries, and 3% of these have central nervous system (CNS) involvement confirmed by leukemic cells in the cerebrospinal fluid (CSF) or neurological symptoms. We sought to determine the significance of neuraxis imaging in such patients.

PROCEDURE: Magnetic resonance images of children aged 1-17.9 with CNS leukemia at diagnosis of ALL were centrally reviewed and clinical data were retrieved from the medical records and the Nordic leukemia registry. Patients were diagnosed in the period 2000-2012 in Sweden, Finland, or Denmark.

RESULTS: The cohort comprised 1,877 patients, and 66 (3.5%) had CNS involvement. Forty-five percent (30/66) had CNS related symptoms. Symptoms included vomiting, facial palsy, headache, visual symptoms, and impaired hearing. CNS imaging was performed in 32 of 66 children (48%), and confirmed CNS involvement in 6 of 21 patients with symptoms (29%) and 5 of 11 (45%) without (P = 0.44). There was no difference in the overall survival between CNS-positive patients with and without signs of leukemic involvement by imaging (P = 0.53).

CONCLUSIONS: Radiological imaging of asymptomatic children with CNS leukemia at diagnosis lacks clinical importance, but may be useful in patients with cranial nerve symptoms and negative CSF, as well as for follow-up. Imaging of symptomatic patients is warranted in order to exclude other causes underlying the symptoms.

Original language	English
Journal	Pediatric Blood & Cancer
Volume	64
Issue number	1
Pages (from-to)	64-70
Number of pages	7
ISSN	1545-5009
DOIs	https://doi.org/10.1002/pbc.26182
Publication status	Published - 1 Jan 2017

Keywords

Adolescent
Central Nervous System Neoplasms/diagnosis
Child
Child, Preschool
Female
Follow-Up Studies
Humans
Infant
Male
Neoplasm Staging
Neuroimaging/methods
Precursor Cell Lymphoblastic Leukemia-Lymphoma/physiopathology
Prognosis
Retrospective Studies
Scandinavian and Nordic Countries
Survival Rate

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10.1002/pbc.26182

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Ranta, S., Palomäki, M., Levinsen, M., Taskinen, M., Abrahamsson, J., Mellgren, K., Niinimäki, R., Schmiegelow, K., Heyman, M., Harila-Saari, A., & Nordic Society of Pediatric Hematology and Oncology (NOPHO) (2017). Role of neuroimaging in children with acute lymphoblastic leukemia and central nervous system involvement at diagnosis. Pediatric Blood & Cancer, 64(1), 64-70. https://doi.org/10.1002/pbc.26182

Ranta, S, Palomäki, M, Levinsen, M, Taskinen, M, Abrahamsson, J, Mellgren, K, Niinimäki, R, Schmiegelow, K, Heyman, M, Harila-Saari, A & Nordic Society of Pediatric Hematology and Oncology (NOPHO) 2017, 'Role of neuroimaging in children with acute lymphoblastic leukemia and central nervous system involvement at diagnosis', Pediatric Blood & Cancer, vol. 64, no. 1, pp. 64-70. https://doi.org/10.1002/pbc.26182

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title = "Role of neuroimaging in children with acute lymphoblastic leukemia and central nervous system involvement at diagnosis",

abstract = "BACKGROUND: Each year approximately 200 children and adolescents are diagnosed with acute lymphoblastic leukemia (ALL) in the five Nordic countries, and 3% of these have central nervous system (CNS) involvement confirmed by leukemic cells in the cerebrospinal fluid (CSF) or neurological symptoms. We sought to determine the significance of neuraxis imaging in such patients.PROCEDURE: Magnetic resonance images of children aged 1-17.9 with CNS leukemia at diagnosis of ALL were centrally reviewed and clinical data were retrieved from the medical records and the Nordic leukemia registry. Patients were diagnosed in the period 2000-2012 in Sweden, Finland, or Denmark.RESULTS: The cohort comprised 1,877 patients, and 66 (3.5%) had CNS involvement. Forty-five percent (30/66) had CNS related symptoms. Symptoms included vomiting, facial palsy, headache, visual symptoms, and impaired hearing. CNS imaging was performed in 32 of 66 children (48%), and confirmed CNS involvement in 6 of 21 patients with symptoms (29%) and 5 of 11 (45%) without (P = 0.44). There was no difference in the overall survival between CNS-positive patients with and without signs of leukemic involvement by imaging (P = 0.53).CONCLUSIONS: Radiological imaging of asymptomatic children with CNS leukemia at diagnosis lacks clinical importance, but may be useful in patients with cranial nerve symptoms and negative CSF, as well as for follow-up. Imaging of symptomatic patients is warranted in order to exclude other causes underlying the symptoms.",

keywords = "Adolescent, Central Nervous System Neoplasms/diagnosis, Child, Child, Preschool, Female, Follow-Up Studies, Humans, Infant, Male, Neoplasm Staging, Neuroimaging/methods, Precursor Cell Lymphoblastic Leukemia-Lymphoma/physiopathology, Prognosis, Retrospective Studies, Scandinavian and Nordic Countries, Survival Rate",

author = "Susanna Ranta and Maarit Palom{\"a}ki and Mette Levinsen and Mervi Taskinen and Jonas Abrahamsson and Karin Mellgren and Riitta Niinim{\"a}ki and Kjeld Schmiegelow and Mats Heyman and Arja Harila-Saari and {Nordic Society of Pediatric Hematology and Oncology (NOPHO)}",

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TY - JOUR

T1 - Role of neuroimaging in children with acute lymphoblastic leukemia and central nervous system involvement at diagnosis

AU - Ranta, Susanna

AU - Palomäki, Maarit

AU - Levinsen, Mette

AU - Taskinen, Mervi

AU - Abrahamsson, Jonas

AU - Mellgren, Karin

AU - Niinimäki, Riitta

AU - Schmiegelow, Kjeld

AU - Heyman, Mats

AU - Harila-Saari, Arja

AU - Nordic Society of Pediatric Hematology and Oncology (NOPHO)

PY - 2017/1/1

Y1 - 2017/1/1

N2 - BACKGROUND: Each year approximately 200 children and adolescents are diagnosed with acute lymphoblastic leukemia (ALL) in the five Nordic countries, and 3% of these have central nervous system (CNS) involvement confirmed by leukemic cells in the cerebrospinal fluid (CSF) or neurological symptoms. We sought to determine the significance of neuraxis imaging in such patients.PROCEDURE: Magnetic resonance images of children aged 1-17.9 with CNS leukemia at diagnosis of ALL were centrally reviewed and clinical data were retrieved from the medical records and the Nordic leukemia registry. Patients were diagnosed in the period 2000-2012 in Sweden, Finland, or Denmark.RESULTS: The cohort comprised 1,877 patients, and 66 (3.5%) had CNS involvement. Forty-five percent (30/66) had CNS related symptoms. Symptoms included vomiting, facial palsy, headache, visual symptoms, and impaired hearing. CNS imaging was performed in 32 of 66 children (48%), and confirmed CNS involvement in 6 of 21 patients with symptoms (29%) and 5 of 11 (45%) without (P = 0.44). There was no difference in the overall survival between CNS-positive patients with and without signs of leukemic involvement by imaging (P = 0.53).CONCLUSIONS: Radiological imaging of asymptomatic children with CNS leukemia at diagnosis lacks clinical importance, but may be useful in patients with cranial nerve symptoms and negative CSF, as well as for follow-up. Imaging of symptomatic patients is warranted in order to exclude other causes underlying the symptoms.

AB - BACKGROUND: Each year approximately 200 children and adolescents are diagnosed with acute lymphoblastic leukemia (ALL) in the five Nordic countries, and 3% of these have central nervous system (CNS) involvement confirmed by leukemic cells in the cerebrospinal fluid (CSF) or neurological symptoms. We sought to determine the significance of neuraxis imaging in such patients.PROCEDURE: Magnetic resonance images of children aged 1-17.9 with CNS leukemia at diagnosis of ALL were centrally reviewed and clinical data were retrieved from the medical records and the Nordic leukemia registry. Patients were diagnosed in the period 2000-2012 in Sweden, Finland, or Denmark.RESULTS: The cohort comprised 1,877 patients, and 66 (3.5%) had CNS involvement. Forty-five percent (30/66) had CNS related symptoms. Symptoms included vomiting, facial palsy, headache, visual symptoms, and impaired hearing. CNS imaging was performed in 32 of 66 children (48%), and confirmed CNS involvement in 6 of 21 patients with symptoms (29%) and 5 of 11 (45%) without (P = 0.44). There was no difference in the overall survival between CNS-positive patients with and without signs of leukemic involvement by imaging (P = 0.53).CONCLUSIONS: Radiological imaging of asymptomatic children with CNS leukemia at diagnosis lacks clinical importance, but may be useful in patients with cranial nerve symptoms and negative CSF, as well as for follow-up. Imaging of symptomatic patients is warranted in order to exclude other causes underlying the symptoms.

KW - Adolescent

KW - Central Nervous System Neoplasms/diagnosis

KW - Child

KW - Child, Preschool

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Infant

KW - Male

KW - Neoplasm Staging

KW - Neuroimaging/methods

KW - Precursor Cell Lymphoblastic Leukemia-Lymphoma/physiopathology

KW - Prognosis

KW - Retrospective Studies

KW - Scandinavian and Nordic Countries

KW - Survival Rate

U2 - 10.1002/pbc.26182

DO - 10.1002/pbc.26182

M3 - Journal article

C2 - 27555087

SN - 1545-5009

VL - 64

SP - 64

EP - 70

JO - Pediatric Blood and Cancer

JF - Pediatric Blood and Cancer

IS - 1

ER -

Role of neuroimaging in children with acute lymphoblastic leukemia and central nervous system involvement at diagnosis

Abstract

Keywords

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