Article Figures & Data
Figures
- FIG 1.
Brain MR images of an 8-year-old boy (patient 1) with definite nelarabine-induced toxicity. The CSF examination was negative for leukemic involvement. Axial FLAIR images with additional fat saturation (A–C and F–H), axial DWI (D and I), and corresponding ADC maps (E and J). Brain MR imaging performed 3 days PA demonstrated mild cerebral volume loss, but findings were otherwise normal (not shown). Follow-up brain MRIs 12 days PA (not shown), 30 days PA (A–E), and 49 days PA (F–J) demonstrate increasingly progressive T2-weighted/FLAIR hyperintensity, beginning as patchy areas in the cortical and subcortical regions (arrows in A and B) and expanding to confluent increased T2-weighted/FLAIR signal throughout the entire supratentorial subcortical, periventricular, and deep WM (arrows in F and G) as well as cortical regions. In addition, there was development of abnormal T2-weighted/FLAIR signal within the pons bilaterally (arrows in C and H) with transient corresponding diffusion restriction in the pons on the right side (arrows in D and E) and increased diffusion signal in the pons bilaterally (arrows in I) without definite decreased intensity on the corresponding ADC map on follow-up 49 days PA (J).
- FIG 2.
Brain MR images (49 days PA) of an 8-year-old boy (patient 1) with definite nelarabine-induced toxicity. The CSF examination was negative for leukemic involvement. Coronal T1+C (A and B) demonstrates slight enhancement of cranial nerve II (cisternal portion, arrows in A) and avid enhancement of cranial nerves III and V (arrows in B). In addition, the confluent leukoencephalopathy and a slight cerebral volume loss with progressing ex vacuo widening of the ventricles are evident.
- FIG 3.
Spinal MR images (49 days PA) of an 8-year-old boy (patient 1) with definite nelarabine-induced toxicity. The CSF examination was negative for leukemic involvement. Axial T2-weighted images (A and B) at the level of C5 and T10, respectively, and sagittal T2-weighted image (C). Images show abnormal T2 hyperintensities throughout the spinal cord, most prominent in the dorsal aspects (arrows in A, B, and C).
- FIG 4.
Brain MR images of a 14-year-old boy (patient 2) with definite nelarabine-induced toxicity. The CSF examination was negative for leukemic involvement. Axial FLAIR images (A–F and J–L) and axial FLAIR with additional fat saturation (G–I). During 5 months (exemplary MR images at 13, 38, 50, and 77 days PA are shown), the patient first demonstrated features of PRES in the occipital, parietal, frontal, and temporal lobes (arrows in A–C), followed by progressive leukoencephalopathy with increased T2-weighted/FLAIR signal starting occipitally and spreading across the pre- and postcentral gyrus and parietal and frontal WM to diffusely affect the WM (arrows in D–L). In addition, progressive global atrophy is clearly evident.
- FIG 5.
Brain MR images (13 days PA) of a 14-year-old boy (patient 2) with definite nelarabine-induced toxicity. The CSF examination was negative for leukemic involvement. Axial T1+C (A and B) demonstrates exemplary enhancement of the cranial nerves III (arrows in A) and V (arrows in B).
- FIG 6.
Spinal MR images (38 days PA) of a 14-year-old boy (patient 2) with definite nelarabine-induced toxicity. CSF examination was negative for leukemic involvement. Axial T2-weighted image (A) shows abnormal signal in the bilateral posterior columns (arrow). Axial T1+C (B) at the level of the conus medullaris demonstrates diffuse enhancement of the ventral and dorsal nerve roots of the cauda equina (arrowheads). In addition, there is diffuse enhancement of the paraspinal musculature reflecting acute denervation edema (arrows in B). Sagittal T2-weighted image (C) demonstrates longitudinally extensive dorsal column involvement extending from the cervicomedullary junction through the conus (arrows).
- FIG 7.
Brain MR imaging obtained in a 10-year-old boy (patient 3) with probable nelarabine-induced toxicity. The CSF examination was negative for leukemic involvement. Axial FLAIR with additional fat-saturation (A, C, and E) and coronal T2-weighted (B, D, and F) images obtained 24, 139, and 154 days PA. Images (A and B) show increased T2-weighted/FLAIR signal in the periventricular and deep WM, predominantly frontoparietal (arrows in A and B). Two follow-up MRIs (C and D and E and F) demonstrate progressive periventricular and deep WM elevated signal (arrows in C, D, E, and F).
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