Disseminated necrotizing leukoencephalopathy following chemoradiation therapy for acute lymphoblastic leukemia.
Disseminated necrotizing leukoencephalopathy (DNL) is a potentially fatal complication of treatment involving intrathecal administration of chemotherapeutic agents such as methotrexate (MTX) alone or in combination with cranial radiotherapy (RT). We describe a case of acute lymphoblastic leukemia (ALL) treated with high-dose intravenous and intrathecal methotrexate combined with craniospinal RT resulting in DNL. Typical MR imaging features of progressive deep white matter lesions showing a characteristic pattern of enhancement after contrast was seen in this case. Deep white matter lesions with ring-like enhancement and calcifications were seen on CT; it showed a mass effect at one stage, which is not typical for DNL. Long-term clinical and imaging follow-up were helpful for the diagnosis in this case.
Pande
Ajaya R
AR
Department of Radiology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan. ajaya_pande@yahoo.com
Ando
Kumiko
K
Ishikura
Reiichi
R
Nagami
Yuki
Y
Ogawa
Masayo
M
Kamikonya
Norihiko
N
Kaneda
Yumi
Y
Tanizawa
Takakuni
T
Nakao
Norio
N
D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects* / Q000627:therapeutic use; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D001927:Brain Diseases / Q000175:diagnosis / Q000209:etiology*; D002675:Child, Preschool; D003131:Combined Modality Therapy; D016371:Cranial Irradiation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008727:Methotrexate / Q000009:adverse effects* / Q000627:therapeutic use; D009336:Necrosis; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000532:radiotherapy*; D014057:Tomography, X-Ray Computed
D000964:Antimetabolites, Antineoplastic; D008727:Methotrexate