title: Intramuscular leukemic relapse: clinical signs and imaging findings. A multicentric analysis.
abstract: OBJECTIVE
  Leukemia is a group of malignant diseases involving peripheral blood and bone marrow. Extramedullary tumor manifestation in leukemia can also occur. They more often involve lymph nodes, skin, and bones. Intramuscular leukemic relapse (ILR) is very unusual. The aim of this analysis was to summarize the reported data regarding clinical signs and radiological features of ILR.
  
  
  METHODS
  The PubMed database was searched for publications related to ILR. After an analysis of all identified articles, 20 publications matched the inclusion criteria. The authors of the 20 publications were contacted and provided imaging of their cases for review. The following were recorded: age, gender, primary diagnosis, clinical signs, pattern, localization and size of the intramuscular leukemic relapse. Images of 16 patients were provided [8 computer tomographic (CT) images and 15 magnetic resonance images, MRI]. Furthermore, one patient with ILR was identified in our institutional database. Therefore, images of 17 patients were available for further analysis.
  
  
  RESULTS
  Overall, 32 cases with ILR were included in the analysis. In most cases acute myeloid leukemia was diagnosed. Most ILRs were localized in the extremities (44 %) and in the extraocular muscles (44 %). Clinically, ILR manifested as local pain, swelling and muscle weakness. Radiologically, ILR presented most frequently with diffuse muscle infiltration. On postcontrast CT/MRI, most lesions demonstrated homogeneous enhancement. ILRs were hypo-/isointense on T1w and hyperintense on T2w images.
  
  
  CONCLUSIONS
  ILR manifests commonly as focal pain, swelling and muscle weakness. ILR predominantly involved the extraocular musculature and the extremities. Radiologically, diffuse muscle infiltration was the most common imaging finding.
authors.affiliation: Department of Radiology, Martin Luther University Halle-Wittenberg, Halle, Germany, alex.surow@medizin.uni-halle.de
authors.forename: Alexey
authors.initials: A
authors.lastname: Surov
authors.affiliation: Department of Ophthalmology, Hacettepe University School of Medicine, Ankara, Turkey. hayyamkiratli@gmail.com
authors.forename: Hayyam
authors.initials: H
authors.lastname: Kiratli
authors.affiliation: Department of Radiology, Seoul St. Mary's Hospital, Seoul, Republic of Korea. saim@catholic.ac.kr
authors.forename: Soo Ah
authors.initials: SA
authors.lastname: Im
authors.affiliation: Department of Neurology, National Hospital Organization Okayama Medical Center, Okayama, Japan. ymanabe@okayama3.hosp.go.jp
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Manabe
authors.affiliation: Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA. ailbheconeill@yahoo.co.uk
authors.forename: Alibhe
authors.initials: A
authors.lastname: O'Neill
authors.affiliation: ASHINAGARE@PARTNERS.ORG
authors.forename: Atul B
authors.initials: AB
authors.lastname: Shinagare
authors.affiliation: Department of Diagnostic and Inverventional Radiology, University of Leipzig, Leipzig, Germany.
authors.forename: Rolf Peter
authors.initials: RP
authors.lastname: Spielmann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007223:Infant; D007938:Leukemia / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019042:Muscle Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000628:therapy; D011856:Radiographic Image Enhancement; D012008:Recurrence; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D003287:Contrast Media