Background:
Leukemia is the most common pediatric malignancy. Central Nervous
System (CNS) is the most frequently involved extramedullary location at diagnosis and at relapse.
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Objective: To determine if Magnetic Resonance Imaging (MRI) findings of optic nerves should
contribute to early detection of CNS relapse in pediatric leukemia.
Methods:
Twenty patients (10 boys, 10 girls; mean age 8,3 years, range 4-16 years) with proven
CNS relapse of leukemia followed up between 2009 and 2017 in our institution were included. Orbital
MRI exams performed before and during CNS relapse were reviewed retrospectively. Forty
optic nerves with Optic Nerve Sheaths (ONS) and Optic Nerve Heads (ONH) were evaluated on
fat-suppressed T2-weighted TSE axial MR images. ONS diameter was measured from the point 10
mm posterior to the globe. ONS distension and ONH configuration were graded as 0, 1 and 2.
Results:
Before CNS relapse, right mean ONS diameter was 4.52 mm and left was 4.61 mm which
were 5.68 mm and 5.66 mm respectively during CNS relapse showing a mean increase of 25% on
right and 22% on left. During CNS relapse, ONS showed grade 0 distension in 15%, grade 1 in
60%, grade 2 in 25% and ONH demonstrated grade 0 configuration in 70%, grade 1 in 25% and
grade 2 in 5% of the patients.
Conclusion:
MRI findings of optic nerves may contribute to diagnose CNS relapse by demonstrating
elevated intracranial pressure in children with leukemia.