DOI: 10.1148/rg.272065088
Imaging the Complications of Bone Marrow Transplantation in Children1
Daniel S. Levine, MBChB2,
Oscar M. Navarro, MD,
Gulraiz Chaudry, MBChB,
John J. Doyle, MD and
Susan I. Blaser, MD
1 From the Department of Diagnostic Imaging (D.S.L., O.M.N., G.C., S.I.B.) and the Department of Pediatrics, Division of Hematology/Oncology (J.J.D.), Hospital for Sick Children and University of Toronto, 555 University Ave, Toronto, Ontario, Canada M5G 1X8. Recipient of a Certificate of Merit award for an education exhibit at the 2005 RSNA Annual Meeting. Received May 3, 2006; revision requested June 5 and received July 19; accepted July 21. J.J.D. is a medical consultant for Insception Biosciences, Toronto, Ontario, Canada; all remaining authors have no financial relationships to disclose.
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Figure 1. Idiopathic interstitial pneumonitis in a 14-year-old boy 8 months after bone marrow transplantation for acute lymphoblastic leukemia. CT image shows extensive bilateral ground-glass opacities and pleural effusions.
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Figure 2. Fungal abscess in a 15-year-old boy 1 year after bone marrow transplantation for acute lympho-blastic leukemia. CT image shows confluent areas of consolidation in the lower lobe of the right lung, with a central region of cavitation (arrows) that represents an abscess. An Aspergillus species grew at laboratory culture of a lobectomy specimen.
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Figure 3. Pulmonary hemorrhage in an 11-month-old boy 3 weeks after bone marrow transplantation for Hurler syndrome. CT image shows bilateral basal ground-glass opacities and pleural effusions, features that would be found also in the presence of infection and pulmonary edema.
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Figure 5. Bronchiolitis obliterans in a 2-year-old girl 9 months after bone marrow transplantation for severe combined immunodeficiency. CT image shows areas of mosaic attenuation and air trapping in both lungs.
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Figure 6. Small-bowel GVH disease in a 7-year-old boy 2 months after bone marrow transplantation for aplastic anemia. CT image shows multiple fluid-filled bowel loops with increased wall enhancement. The differential diagnosis included infective enteritis and mucositis secondary to chemotherapy.
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Figure 7. Infective enteritis in a 3-year-old boy 1 week after autologous bone marrow transplantation for neuroblastoma. CT image shows diffuse small- and large-bowel wall enhancement with focal wall thickening in the jejunum and descending colon (arrows). The differential diagnosis included chemotherapy-induced mucositis, but GVH disease was excluded because the transplant was autologous.
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Figure 8a. Neutropenic colitis in a 6-year-old girl 3 months after bone marrow transplantation for lymphoma. (a) US image shows marked thickening of the cecum. (b) CT image shows marked thickening and increased enhancement of the fluid-filled cecum and terminal ileum.
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Figure 8b. Neutropenic colitis in a 6-year-old girl 3 months after bone marrow transplantation for lymphoma. (a) US image shows marked thickening of the cecum. (b) CT image shows marked thickening and increased enhancement of the fluid-filled cecum and terminal ileum.
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Figure 9. Pneumatosis coli in a 6-year-old girl 6 months after bone marrow transplantation for severe combined immunodeficiency. CT image shows marked pneumatosis in the colon (black arrows) and adjacent mesentery (white arrows). There was no evidence of concurrent typhlitis.
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Figure 10a. Hepatic veno-occlusive disease in a 21-month-old boy 3 weeks after bone marrow transplantation for thalassemia. (a) Gray-scale US image shows hepatomegaly. (b) Color Doppler US image shows reversal of the main portal venous flow. At subsequent biopsy, veno-occlusive disease was found.
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Figure 10b. Hepatic veno-occlusive disease in a 21-month-old boy 3 weeks after bone marrow transplantation for thalassemia. (a) Gray-scale US image shows hepatomegaly. (b) Color Doppler US image shows reversal of the main portal venous flow. At subsequent biopsy, veno-occlusive disease was found.
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Figure 11a. Visceral fungal infection. (a) High-resolution US image obtained with a linear-array transducer shows a hypoechoic splenic nodule in an 8-year-old girl 6 weeks after bone marrow transplantation for acute lymphoid leukemia. (b) Contrast material–enhanced CT image shows multiple lesions in the kidneys, liver, and spleen in a 7-year-old boy 5 days after bone marrow transplantation for acute lymphoid leukemia. All the lesions were believed to have been caused by the same fungus.
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Figure 11b. Visceral fungal infection. (a) High-resolution US image obtained with a linear-array transducer shows a hypoechoic splenic nodule in an 8-year-old girl 6 weeks after bone marrow transplantation for acute lymphoid leukemia. (b) Contrast material–enhanced CT image shows multiple lesions in the kidneys, liver, and spleen in a 7-year-old boy 5 days after bone marrow transplantation for acute lymphoid leukemia. All the lesions were believed to have been caused by the same fungus.
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Figure 12a. Regenerative hepatic nodules in a 10-year-old boy 8 years after bone marrow transplantation for neuroblastoma. (a) CT image shows multiple enhancing hepatic nodules that had grown slowly over several years. (b) T1-weighted MR image shows the nodules as round areas of signal hypointensity compared with the signal intensity of the normal hepatic parenchyma. (c) Contrast-enhanced arterial phase MR image shows avid enhancement of the nodules in comparison with the normal hepatic parenchyma.
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Figure 12b. Regenerative hepatic nodules in a 10-year-old boy 8 years after bone marrow transplantation for neuroblastoma. (a) CT image shows multiple enhancing hepatic nodules that had grown slowly over several years. (b) T1-weighted MR image shows the nodules as round areas of signal hypointensity compared with the signal intensity of the normal hepatic parenchyma. (c) Contrast-enhanced arterial phase MR image shows avid enhancement of the nodules in comparison with the normal hepatic parenchyma.
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Figure 12c. Regenerative hepatic nodules in a 10-year-old boy 8 years after bone marrow transplantation for neuroblastoma. (a) CT image shows multiple enhancing hepatic nodules that had grown slowly over several years. (b) T1-weighted MR image shows the nodules as round areas of signal hypointensity compared with the signal intensity of the normal hepatic parenchyma. (c) Contrast-enhanced arterial phase MR image shows avid enhancement of the nodules in comparison with the normal hepatic parenchyma.
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Figure 13. Hepatic iron deposition in a 5-year-old boy 4 months after bone marrow transplantation for acute lymphoblastic leukemia. T2-weighted fat-saturated MR image shows marked signal hypointensity in the liver in comparison with the muscles and spleen. Ascites also is visible.
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Figure 14. Hemorrhagic cystitis in a 7-year-old girl 1 month after bone marrow transplantation for acute lymphoblastic leukemia. CT image shows marked wall thickening and increased mucosal enhancement of the bladder after treatment with cyclophosphamide.
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Figure 15. Adenoidal posttransplantation lympho-proliferative disorder in a 12-year-old boy 8 years after bone marrow transplantation for acute lymphoblastic leukemia. CT image shows enlargement of the right-sided adenoidal tissue (arrows), which at biopsy was proved to be due to posttransplantation lymphoprolif-erative disorder. Opacification of the left maxillary sinus also is evident.
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Figure 16. Bone infarcts in a 13-year-old girl 1 year after bone marrow transplantation for lymphoma. Coronal T1-weighted MR image shows multiple geographic areas of abnormal signal intensity in the metaphyses and diaphyses of both femora and tibiae.
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Figure 17. Avascular necrosis of the knee in a 15-year-old boy 4 months after bone marrow transplantation for acute myeloid leukemia. Coronal short inversion time inversion recovery MR image shows geographic areas of avascular necrosis in the epiphyses at both knee joints.
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Figure 18. Talar avascular necrosis in a 7-year-old boy 10 months after bone marrow transplantation for Fanconi anemia. Coronal short inversion time inversion recovery MR image shows signal hyperintensity in the medial aspect of the talar dome, a finding that represents edema.
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Figure 19. Renal atrophy in a 10-year-old boy 8 years after bone marrow transplantation for neuroblastoma. CT image shows atrophy of the left kidney and of the subcutaneous fat and musculature in the left side of the abdomen, conditions secondary to radiation therapy.
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Figure 20a. Tumor recurrence in a 5-year-old girl after bone marrow transplantation for neuroblastoma. (a) CT image obtained 21 months after transplantation shows a recurrent left paravertebral soft-tissue mass (arrows). (b) CT image obtained 4 months earlier shows no evidence of the mass.
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Figure 20b. Tumor recurrence in a 5-year-old girl after bone marrow transplantation for neuroblastoma. (a) CT image obtained 21 months after transplantation shows a recurrent left paravertebral soft-tissue mass (arrows). (b) CT image obtained 4 months earlier shows no evidence of the mass.
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Figure 21a. Cerebral Epstein-Barr viral infection in an 11-year-old boy 4 months after bone marrow transplantation for acute lymphoblastic leukemia. (a) Fluid-attenuated inversion recovery MR image shows a lesion in the deep gray matter on the left side. (b) Gadolinium-enhanced MR image shows rimlike enhancement of the lesion in a, as well as a second lesion with similar features in the right temporal lobe. The signal hyperintensity in the periventricular white matter is likely treatment related.
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Figure 21b. Cerebral Epstein-Barr viral infection in an 11-year-old boy 4 months after bone marrow transplantation for acute lymphoblastic leukemia. (a) Fluid-attenuated inversion recovery MR image shows a lesion in the deep gray matter on the left side. (b) Gadolinium-enhanced MR image shows rimlike enhancement of the lesion in a, as well as a second lesion with similar features in the right temporal lobe. The signal hyperintensity in the periventricular white matter is likely treatment related.
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Figure 22. Cerebral hemorrhage in an 8-year-old boy 6 weeks after bone marrow transplantation for acute myeloid leukemia. CT image shows an acute hemorrhage in the left frontal lobe.
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Figure 23. Intraocular hemorrhage in a 7-year-old boy 2 months after bone marrow transplantation for aplastic anemia. Unenhanced CT image shows the hemorrhage as an area of increased attenuation in the posterior aspect of the left globe.
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Figure 24. Subdural hemorrhage in a 21-month-old boy 1 month after bone marrow transplantation for thalassemia. T1-weighted MR image shows an extensive bilateral subacute subdural hemorrhage.
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Figure 25. Cerebral infarcts in an 8-year-old boy 4 weeks after bone marrow transplantation for acute myeloid leukemia. CT image shows extensive bilateral parenchymal infarcts secondary to mucormycosis-induced endocarditis.
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Figure 26a. Radiation-induced cerebral telangiectasia (cavernoma) in a 12-year-old boy 8 years after bone marrow transplantation for acute lymphoblastic leukemia. (a) Contrast-enhanced CT image shows a bilobed lesion with rimlike enhancement in the left temporal lobe. (b) Fluid-attenuated inversion recovery MR image shows signal hypointensity in the hemo-siderin-stained rim of the lesion.
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Figure 26b. Radiation-induced cerebral telangiectasia (cavernoma) in a 12-year-old boy 8 years after bone marrow transplantation for acute lymphoblastic leukemia. (a) Contrast-enhanced CT image shows a bilobed lesion with rimlike enhancement in the left temporal lobe. (b) Fluid-attenuated inversion recovery MR image shows signal hypointensity in the hemo-siderin-stained rim of the lesion.
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Figure 27. Posterior reversible encephalopathy syndrome in a 5-year-old boy 9 months after bone marrow transplantation for neuroblastoma. Fluid-attenuated inversion recovery MR image shows a characteristic posterior wedge-shaped cortical and subcortical area of abnormal signal hyperintensity.
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Figure 28a. Radiation-induced cerebral malignancy in an 18-year-old boy 10 years after bone marrow transplantation for acute lymphoblastic leukemia. (a) Contrast-enhanced T1-weighted MR image shows a lesion with rimlike enhancement in the left frontal lobe. (b) T2-weighted MR image shows the lesion with a marked mass effect, loss of gray matter–white matter differentiation, and edema. Glioblastoma multiforme was diagnosed at biopsy.
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Figure 28b. Radiation-induced cerebral malignancy in an 18-year-old boy 10 years after bone marrow transplantation for acute lymphoblastic leukemia. (a) Contrast-enhanced T1-weighted MR image shows a lesion with rimlike enhancement in the left frontal lobe. (b) T2-weighted MR image shows the lesion with a marked mass effect, loss of gray matter–white matter differentiation, and edema. Glioblastoma multiforme was diagnosed at biopsy.
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Figure 29. Maxillary sinusitis in a 6-year-old boy 10 days after bone marrow transplantation for lymphoma. CT image of the maxillary sinuses shows mucosal thickening in the right sinus and an air-fluid level in the left sinus.
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Figure 30a. Invasive fungal sinusitis in a 6-year-old girl 3 months after bone marrow transplantation for aplastic anemia. (a) Axial CT image shows bilateral maxillary sinus opacification, complete on the left, and premalar soft-tissue swelling and infiltration. (b) Axial CT image shows periorbital soft-tissue swelling and a subperiosteal abscess (arrow) with destruction of the orbital plate of the ethmoid bone.
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Figure 30b. Invasive fungal sinusitis in a 6-year-old girl 3 months after bone marrow transplantation for aplastic anemia. (a) Axial CT image shows bilateral maxillary sinus opacification, complete on the left, and premalar soft-tissue swelling and infiltration. (b) Axial CT image shows periorbital soft-tissue swelling and a subperiosteal abscess (arrow) with destruction of the orbital plate of the ethmoid bone.
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Copyright © 2007 by the Radiological Society of North America.
