MRI Findings in Patients With Leukemia and Positive CSF Cytology: A Single-Institution 5-Year Experience.
OBJECTIVE
The purposes of this study were to describe the spectrum of MRI findings and determine the prognostic role of MRI in adults with acute leukemia with positive CSF cytology.


METHODS
In this retrospective study of 34 patients (19 women, 15 men; mean age, 51 years; range, 18-72 years) treated for CNS leukemia between 2006 and 2011, 31 (91%) contrast-enhanced brain and 14 (41%) spine MRI studies were reviewed by two radiologists to note patterns of enhancement. Interobserver agreement and correlation of enhancement with outcome were analyzed.


RESULTS
MRI showed abnormal findings in 25 patients (74%). Pachymeningeal enhancement (n = 9/31, 29%), leptomeningeal enhancement (n = 6/31, 19%), cranial nerve enhancement (n = 9/31, 29%), masslike enhancement (n = 3/31, 10%), and spinal meningeal enhancement (n = 10/14, 71%) were identified. There was strong interobserver agreement (κ = 0.906). Survival rates were shorter to a statistically significant degree with pachymeningeal enhancement (median, 7 months; interquartile range [IQR], 5-8 months versus median, 26 months; IQR, 15 months to not reached; p = 0.004) and two or more sites of enhancement (median, 8 months; IQR, 3-13 months versus median, 19 months; IQR, 9 months to not reached; p = 0.046).


CONCLUSIONS
Brain or spine MRI examinations (or both) showed abnormal findings in nearly three-fourths of adults with acute leukemia with positive CSF cytology who were imaged for neurologic symptoms. Pachymeningeal enhancement and two or more sites of brain involvement were associated with shorter survival.
1 Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115.
Jeffrey P
JP
Guenette
1 Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115.|2 Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA.
Sree Harsha
SH
Tirumani
1 Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115.
Abhishek R
AR
Keraliya
1 Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115.|2 Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA.
Atul B
AB
Shinagare
1 Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115.|2 Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA.
Nikhil H
NH
Ramaiya
1 Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115.|2 Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA.
Jyothi P
JP
Jagannathan
D000293:Adolescent; D000328:Adult; D000368:Aged; D001900:Boston / Q000453:epidemiology; D001932:Brain Neoplasms / Q000134:cerebrospinal fluid / Q000000981:diagnostic imaging* / Q000401:mortality*; D002555:Cerebrospinal Fluid / Q000166:cytology*; D005260:Female; D006801:Humans; D007938:Leukemia / Q000134:cerebrospinal fluid / Q000000981:diagnostic imaging* / Q000401:mortality*; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D015995:Prevalence; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015996:Survival Rate; D055815:Young Adult
CNS; CSF; chloroma; leukemia; myeloid sarcoma