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Published in: European Radiology 10/2012

01-10-2012 | Neuro

Brain imaging findings in symptomatic patients after allogeneic haematopoietic stem cell transplantation: correlation with clinical outcome

Authors: Bihong T. Chen, A. Orlando Ortiz, Andrew Dagis, Cheryl Torricelli, Pablo Parker, Harry Openshaw

Published in: European Radiology | Issue 10/2012

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Abstract

Objective

To investigate the risk factors for, and the incidence of, structural abnormalities on brain imaging in allogeneic haematopoietic stem cell transplant (HSCT) patients, and correlate these findings with survival.

Methods

We retrospectively reviewed all brain computed tomography (CT) and/or magnetic resonance imaging (MRI) studies obtained during the first post-HSCT year from 2004 thru 2007 in allogeneic HSCT recipients.

Results

A total of 128 patients had brain imaging in the first post-HSCT year. Forty one of these 128 patients (32 %) had structural abnormalities on brain imaging: cerebrovascular complications (n = 10), central nervous system (CNS) infection (n = 9), subdural fluid collection (n = 6), CNS recurrence of haematological malignancy (n = 11), and drug toxicity abnormalities (n = 5). The only significant risk factor for structural imaging abnormality was younger patient age (P = 0.01). MRI was significantly more likely than CT to provide specific imaging diagnosis of cerebral lesions (P = 0.001). HSCT patients with cerebrovascular complications have poor survival (P < 0.05). However, overall survival was not significantly worse for the 41 patients with the structural imaging abnormalities as compared to the 87 patients who had brain imaging but no structural abnormalities.

Conclusions

There was no survival difference in patients whose brain imaging was normal or abnormal. However, there was poor outcome in patients with cerebrovascular complications after HSCT.

Key Points

Brain imaging frequently demonstrates neurological complications following haematopoietic stem cell transplantation.
Younger HSCT patients are more likely to exhibit abnormal brain imaging findings.
HSCT recipients with cerebrovascular complications have the worst survival.
However brain imaging results are weak indicators of overall survival after HSCT.
Literature
1.
go back to reference Openshaw H (2004) Neurological complications of hematopoietic cell transplantation. In: Blume KG, Forman SJ, Appelbaum FR (eds) Thomas' hematopoetic cell transplantation. Blackwell, Malden, pp 811–823 Openshaw H (2004) Neurological complications of hematopoietic cell transplantation. In: Blume KG, Forman SJ, Appelbaum FR (eds) Thomas' hematopoetic cell transplantation. Blackwell, Malden, pp 811–823
2.
go back to reference Saiz A, Graus F (2004) Neurological complications of hematopoietic cell transplantation. Semin Neurol 24:427–434PubMedCrossRef Saiz A, Graus F (2004) Neurological complications of hematopoietic cell transplantation. Semin Neurol 24:427–434PubMedCrossRef
3.
go back to reference Weber C, Schaper J, Tibussek D et al (2008) Diagnostic and therapeutic implications of neurological complications following paediatric haematopoietic stem cell transplantation. Bone Marrow Transplant 41:253–259PubMedCrossRef Weber C, Schaper J, Tibussek D et al (2008) Diagnostic and therapeutic implications of neurological complications following paediatric haematopoietic stem cell transplantation. Bone Marrow Transplant 41:253–259PubMedCrossRef
4.
go back to reference Uckan D, Cetin M, Yigitkanli I et al (2005) Life-threatening neurological complications after bone marrow transplantation in children. Bone Marrow Transplant 35:71–76PubMedCrossRef Uckan D, Cetin M, Yigitkanli I et al (2005) Life-threatening neurological complications after bone marrow transplantation in children. Bone Marrow Transplant 35:71–76PubMedCrossRef
5.
go back to reference Nishiguchi T, Mochizuki K, Shakudo M, Takeshita T, Hino M, Inoue Y (2009) CNS complications of hematopoietic stem cell transplantation. AJR Am J Roentgenol 192:1003–1011PubMedCrossRef Nishiguchi T, Mochizuki K, Shakudo M, Takeshita T, Hino M, Inoue Y (2009) CNS complications of hematopoietic stem cell transplantation. AJR Am J Roentgenol 192:1003–1011PubMedCrossRef
6.
go back to reference Padovan CS, Yousry TA, Schleuning M, Holler E, Kolb HJ, Straube A (1998) Neurological and neuroradiological findings in long-term survivors of allogeneic bone marrow transplantation. Ann Neurol 43:627–633PubMedCrossRef Padovan CS, Yousry TA, Schleuning M, Holler E, Kolb HJ, Straube A (1998) Neurological and neuroradiological findings in long-term survivors of allogeneic bone marrow transplantation. Ann Neurol 43:627–633PubMedCrossRef
7.
go back to reference Antonini G, Ceschin V, Morino S et al (1998) Early neurologic complications following allogeneic bone marrow transplant for leukemia: a prospective study. Neurology 50:1441–1445PubMedCrossRef Antonini G, Ceschin V, Morino S et al (1998) Early neurologic complications following allogeneic bone marrow transplant for leukemia: a prospective study. Neurology 50:1441–1445PubMedCrossRef
8.
go back to reference Wiznitzer M, Packer RJ, August CS, Burkey ED (1984) Neurological complications of bone marrow transplantation in childhood. Ann Neurol 16:569–576PubMedCrossRef Wiznitzer M, Packer RJ, August CS, Burkey ED (1984) Neurological complications of bone marrow transplantation in childhood. Ann Neurol 16:569–576PubMedCrossRef
9.
go back to reference Iguchi A, Kobayashi R, Yoshida M et al (1999) Neurological complications after stem cell transplantation in childhood. Bone Marrow Transplant 24:647–652PubMedCrossRef Iguchi A, Kobayashi R, Yoshida M et al (1999) Neurological complications after stem cell transplantation in childhood. Bone Marrow Transplant 24:647–652PubMedCrossRef
10.
go back to reference Furlong TG, Gallucci BB (1994) Pattern of occurrence and clinical presentation of neurological complications in bone-marrow transplant patients. Cancer Nurs 17:27–36PubMedCrossRef Furlong TG, Gallucci BB (1994) Pattern of occurrence and clinical presentation of neurological complications in bone-marrow transplant patients. Cancer Nurs 17:27–36PubMedCrossRef
11.
go back to reference Bartynski WS, Boardman JF (2007) Distinct imaging patterns and lesoion distribution in posterior reversible encephalopathy syndrome. AJNR Am J Neuroradiol 28:1320–1327PubMedCrossRef Bartynski WS, Boardman JF (2007) Distinct imaging patterns and lesoion distribution in posterior reversible encephalopathy syndrome. AJNR Am J Neuroradiol 28:1320–1327PubMedCrossRef
12.
go back to reference Gasparotti R, Pinelli L, Liserre R (2011) New MR sequences in daily practice: susceptibility weighted imaging. A pictorial essay. Insights Imaging 2:335–347PubMedCrossRef Gasparotti R, Pinelli L, Liserre R (2011) New MR sequences in daily practice: susceptibility weighted imaging. A pictorial essay. Insights Imaging 2:335–347PubMedCrossRef
13.
go back to reference Brown MS, Simon JH, Stemmer SM et al (1995) MR and proton spectroscopy of white matter disease induced by high-dose chemotherapy with bone marrow transplant in advanced breast carcinoma. AJNR Am J Neuroradiol 16:2013–2020PubMed Brown MS, Simon JH, Stemmer SM et al (1995) MR and proton spectroscopy of white matter disease induced by high-dose chemotherapy with bone marrow transplant in advanced breast carcinoma. AJNR Am J Neuroradiol 16:2013–2020PubMed
14.
go back to reference Assaf Y, Pasternak O (2008) Diffusion tensor imaging (DTI)-based white matter mapping in brain research: a review. J Mol Neurosci 34:51–61PubMedCrossRef Assaf Y, Pasternak O (2008) Diffusion tensor imaging (DTI)-based white matter mapping in brain research: a review. J Mol Neurosci 34:51–61PubMedCrossRef
15.
go back to reference Gooley TA, Chien JW, Pergam SA et al (2010) Reduced mortality after allogeneic hematopoietic-cell transplantation. N Engl J Med 363:2091–2101PubMedCrossRef Gooley TA, Chien JW, Pergam SA et al (2010) Reduced mortality after allogeneic hematopoietic-cell transplantation. N Engl J Med 363:2091–2101PubMedCrossRef
16.
go back to reference Socie G, Stone JV, Wingard JR et al (1999) Long-term survival and late deaths after allogeneic bone marrow transplantation. Late Effects Working Committee of the International Bone Marrow Transplant Registry. N Engl J Med 341:14–21PubMedCrossRef Socie G, Stone JV, Wingard JR et al (1999) Long-term survival and late deaths after allogeneic bone marrow transplantation. Late Effects Working Committee of the International Bone Marrow Transplant Registry. N Engl J Med 341:14–21PubMedCrossRef
17.
go back to reference Wojnar J, Giebel S, Holowiecka-Goral A et al (2007) Prediction of nonrelapse mortality for patients surviving 100 days after allogeneic hematopoietic stem cell transplantation. Transplant Proc 39:3375–3379PubMedCrossRef Wojnar J, Giebel S, Holowiecka-Goral A et al (2007) Prediction of nonrelapse mortality for patients surviving 100 days after allogeneic hematopoietic stem cell transplantation. Transplant Proc 39:3375–3379PubMedCrossRef
18.
go back to reference Lee JH, Choi SJ, Kim SE et al (2005) Severe metabolic abnormalities after allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 35:63–69PubMedCrossRef Lee JH, Choi SJ, Kim SE et al (2005) Severe metabolic abnormalities after allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 35:63–69PubMedCrossRef
19.
go back to reference Noe A, Cappelli B, Biffi A et al (2010) High incidence of severe cyclosporine neurotoxicity in children affected by haemoglobinopaties undergoing myeloablative haematopoietic stem cell transplantation: early diagnosis and prompt intervention ameliorates neurological outcome. Ital J Pediatr 36:14PubMedCrossRef Noe A, Cappelli B, Biffi A et al (2010) High incidence of severe cyclosporine neurotoxicity in children affected by haemoglobinopaties undergoing myeloablative haematopoietic stem cell transplantation: early diagnosis and prompt intervention ameliorates neurological outcome. Ital J Pediatr 36:14PubMedCrossRef
20.
go back to reference Woodruff BK, Wijdicks EF, Marshall WF (2002) Reversible metronidazole-induced lesions of the cerebellar dentate nuclei. N Engl J Med 346:68–69PubMedCrossRef Woodruff BK, Wijdicks EF, Marshall WF (2002) Reversible metronidazole-induced lesions of the cerebellar dentate nuclei. N Engl J Med 346:68–69PubMedCrossRef
21.
go back to reference Bleggi-Torres LF, de Medeiros BC, Werner B et al (2000) Neuropathological findings after bone marrow transplantation: an autopsy study of 180 cases. Bone Marrow Transplant 25:301–307PubMedCrossRef Bleggi-Torres LF, de Medeiros BC, Werner B et al (2000) Neuropathological findings after bone marrow transplantation: an autopsy study of 180 cases. Bone Marrow Transplant 25:301–307PubMedCrossRef
22.
go back to reference Colosimo M, McCarthy N, Jayasinghe R, Morton J, Taylor K, Durrant S (2000) Diagnosis and management of subdural haematoma complicating bone marrow transplantation. Bone Marrow Transplant 25:549–552PubMedCrossRef Colosimo M, McCarthy N, Jayasinghe R, Morton J, Taylor K, Durrant S (2000) Diagnosis and management of subdural haematoma complicating bone marrow transplantation. Bone Marrow Transplant 25:549–552PubMedCrossRef
23.
go back to reference Openshaw H, Ressler JA, Snyder DS (2008) Lumbar puncture and subdural hygroma and hematomas in hematopoietic cell transplant patients. Bone Marrow Transplant 41:791–795PubMedCrossRef Openshaw H, Ressler JA, Snyder DS (2008) Lumbar puncture and subdural hygroma and hematomas in hematopoietic cell transplant patients. Bone Marrow Transplant 41:791–795PubMedCrossRef
25.
go back to reference Guermazi A, Miaux Y, Lafitte FO, Zahar JR, Gluckman E (2003) CT and MR imaging of central nervous system effects of therapy in patients treated for hematological malignancies. Eur Radiol 13:L202–L214PubMedCrossRef Guermazi A, Miaux Y, Lafitte FO, Zahar JR, Gluckman E (2003) CT and MR imaging of central nervous system effects of therapy in patients treated for hematological malignancies. Eur Radiol 13:L202–L214PubMedCrossRef
26.
go back to reference Miaux Y, Ribaud P, Williams M et al (1995) MR of cerebral aspergillosis in patients who have had bone marrow transplantation. AJNR Am J Neuroradiol 16:555–562PubMed Miaux Y, Ribaud P, Williams M et al (1995) MR of cerebral aspergillosis in patients who have had bone marrow transplantation. AJNR Am J Neuroradiol 16:555–562PubMed
27.
go back to reference Coplin WM, Cochran MS, Levine SR, Crawford SW (2001) Stroke after bone marrow transplantation: frequency, aetiology and outcome. Brain 124:1043–1051PubMedCrossRef Coplin WM, Cochran MS, Levine SR, Crawford SW (2001) Stroke after bone marrow transplantation: frequency, aetiology and outcome. Brain 124:1043–1051PubMedCrossRef
Metadata
Title
Brain imaging findings in symptomatic patients after allogeneic haematopoietic stem cell transplantation: correlation with clinical outcome
Authors
Bihong T. Chen
A. Orlando Ortiz
Andrew Dagis
Cheryl Torricelli
Pablo Parker
Harry Openshaw
Publication date
01-10-2012
Publisher
Springer-Verlag
Published in
European Radiology / Issue 10/2012
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-012-2490-6

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