title: Disseminated necrotizing leukoencephalopathy following chemoradiation therapy for acute lymphoblastic leukemia.
abstract: 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.
authors.affiliation: Department of Radiology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan. ajaya_pande@yahoo.com
authors.forename: Ajaya R
authors.initials: AR
authors.lastname: Pande
authors.forename: Kumiko
authors.initials: K
authors.lastname: Ando
authors.forename: Reiichi
authors.initials: R
authors.lastname: Ishikura
authors.forename: Yuki
authors.initials: Y
authors.lastname: Nagami
authors.forename: Masayo
authors.initials: M
authors.lastname: Ogawa
authors.forename: Norihiko
authors.initials: N
authors.lastname: Kamikonya
authors.forename: Yumi
authors.initials: Y
authors.lastname: Kaneda
authors.forename: Takakuni
authors.initials: T
authors.lastname: Tanizawa
authors.forename: Norio
authors.initials: N
authors.lastname: Nakao
mesh_terms: 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
chemical_list: D000964:Antimetabolites, Antineoplastic; D008727:Methotrexate