Introduction Section 1 Section 2 Section 3 Conclusion and References


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Section 1 - Direct leukemic involvement of the Central Nervous System

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Nonmeningeal disease: Bone marrow abnormality

Bone marrow infiltration:
Active leukemia is associated with bone marrow infiltration; in this process, normal hematopoietic elements and fat are replaced by leukemic cells. The end result is T1 prolongation, readily identified on T1-weighted MRI of the spine as a decrease in signal in the vertebral bodies (case 12). Following bone marrow transplantation (BMT, either autologous or allogeneic), there is a predictable sequence of the MR appearance, as the marrow undergoes the regenerative process. Within 40-90 days following BMT, a pattern of alternating high and low signal may be seen within the vertebral body on T1, with a central region of relatively high signal representing fat, and more peripheral zones of lower signal representing hematopoietic reconstitution. Following this, a more homogeneous pattern emerges which is of intermediate signal, higher than leukemic marrow, but lower than normal fatty marrow. Ultimately, a more normal appearing marrow may emerge. Knowledge of the expected bone marrow appearance on MRI allows recognition of relapses, and can help in understanding the process by which the marrow recovers following transplantation.



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