Michael Eric Stone MD, Presenter: Nothing to Disclose

Karyn Alayne Ledbetter MD, Abstract Co-Author: Nothing to Disclose

Sheena Saleem MD, MBBS, Abstract Co-Author: Nothing to Disclose

Deniz Altinok MD, Abstract Co-Author: Nothing to Disclose

1. Intracerebral hemorrhage is common in patients with acute leukemia accounting for approximately 20% total mortality. 2. Hyperleukocytosis is defined as a peripheral white blood cell count exceeding 100,000/ml and is not uncommon in patients presenting with acute lymphocytic leukemia (ALL). 3. Hyperleukocytosis is associated with intracranial hemorrhage, proposed to occur secondary to venous congestion due to hyperviscosity. Thrombocytopenia is a confounding factor. 4. Larger hemorrhages can be identified on CT or routine MRI sequences. Susceptibility-weighted MRI (SWI) is much more sensitive for detecting chronic petechial hemorrhage and should be considered in all ALL patients with hyperleukocytosis. 5. Imaging findings include diffuse small blooming foci on susceptibility-weighted sequences. These lesions may be faintly seen on diffusion-weighted sequences and should be scrutinized in the absence of dedicated SWI. These imaging findings will be reviewed using case based examples.  

I. INTRODUCTION TO ACUTE LYMPHOCYTIC LEUKEMIA II. HYPERLEUKOCYTOSIS A. DEFINITION B. PATHOPHYSIOLOGY OF HYPERVISCOCITY III. IMAGING FINDINGS OF PETECHIAL HEMMORHAGE IN HYPERLEUKOCYTOSIS A. UTILITY OF STANDARD MRI B. UTILITY OF SUSCPETIBILITY-WEIGHTED IMAGING IV. CASE EXAMPLES V. DIFFERENTIAL CONSIDERATIONS   

http://abstract.rsna.org/uploads/2014/14013351/14013351_o3ei.pdf

Stone, M, Ledbetter, K, Saleem, S, Altinok, D, Susceptibility-Weighted MRI in Acute Lymphocytic Leukemia: Petechial Brain Hemorrhage in the Setting of Hyperleukocytosis.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14013351.html