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Diffuse necrotizing leukoencephalopathy
Imaging features of leukoencephalopathy:
Imaging features of necrotizing leukoencephalopathy include
periventricular white matter hypodensity on CT, and hypo/
hyperintensity on T1/T2-weighted MRI (case
23). With MRI, enhancement may occasionally be seen. MRI has
been shown to be more sensitive in the detection of these changes,
however imaging findings do not always correlate with clinical status.
It has been suggested that monitoring with MRI may detect the earliest
phases of therapeutic toxicity so that treatment can be changed. There
may be imaging evidence of mineralizing microangiopathy, with
calcification in the basal ganglia or subcortical white matter (case
24). Rarely, necrosis may appear mass-like, and mimic neoplasm
(case 25). In some cases, the
imaging findings are reversible. Enhancement may be seen at the
entrance site of the catheter in patients given intraventricular
chemotherapy (case 26)
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