MRI paving the way to diagnosis of acute lymphoblastic leukemia in children and adolescents - a retrospective observational study.
Magnetic resonance imaging-detected bone marrow signal changes contributed to diagnosis in 4.7% of pediatric acute lymphoblastic leukemia cases
MRI paving the way to diagnosis of acute lymphoblastic leukemia in children and adolescents - a retrospective observational study.
Prompt diagnosis of childhood acute lymphoblastic leukemia (acute lymphoblastic leukemia) remains a clinical challenge, particularly in children presenting with normal blood counts and musculoskeletal symptoms.
This study aims to clarify the role of magnetic resonance imaging in the diagnostic pathway of pediatric acute lymphoblastic leukemia and to define radiological findings that should prompt bone marrow examination.
We retrospectively reviewed all patients diagnosed with acute lymphoblastic leukemia at our institution between 2006 and 2024 and included those who underwent magnetic resonance imaging prior to diagnosis.
Due to differing magnetic resonance imaging protocols, the cohort was divided into two groups: one group (n = 17) underwent musculoskeletal imaging and one group (n = 3) underwent imaging of the trunk.
More than one-third of patients (7/20; 35%) had a completely normal complete blood count (complete blood count) at presentation.
Persistent bone pain was the leading symptom, preceding imaging in 18/20 cases.
The mean time from symptom onset to magnetic resonance imaging was 20.8 days (range 1-65), while the mean time from magnetic resonance imaging to diagnosis was 18.4 days (range 0-180).
Magnetic resonance imaging plays an important role in the diagnostic pathway of pediatric acute lymphoblastic leukemia, especially in patients with persistent musculoskeletal pain and normal blood counts.
In our cohort, magnetic resonance imaging examinations could initiate a rapid diagnostic process leading to acute lymphoblastic leukemia confirmation. Diffuse T1w hypointensity and diffusion restriction emerged as key imaging findings.
A normal complete blood count should therefore not delay urgent oncologic assessment when the clinical presentation and magnetic resonance imaging pattern are suspicious for leukemia.