MRI abnormalities in children following sequential chemotherapy, hyperfractionated accelerated radiotherapy and high-dose thiotepa for high-risk primitive neuroectodermal tumours of the central nervous system.

INTRODUCTION: Intensive postsurgical therapies have improved survival in children with primitive neuroectodermal tumour, but there is concern that the combination of chemotherapy and radiotherapy may result in a compound injury to normal brain. The purposes of this analysis were to characterise what types of imaging abnormalities occur, identify risk factors and explore how treatment-related changes may be distinguished from tumour. METHOD: One hundred fifty-three MRI studies in 14 children treated with sequential chemotherapy, hyperfractionated accelerated radiotherapy and high-dose thiotepa were retrospectively analysed at a paediatric national referral centre. RESULTS: We observed 11 episodes of new focal enhancing lesions, 5 of which were transient and judged to be treatment related. In addition, 7/14 (50%) of children demonstrated moderate to severe brain volume loss featuring a leukodystrophy pattern. CONCLUSION: Treatment-related brain MRI abnormalities occurred frequently in this series with a risk of misdiagnosis as tumour. A proportion of patients suffer generalised white matter injury, which has not been appreciated as a side effect of this particular therapy.

Biliary involvement in Hodgkin's disease.

Hodgkin's disease (HD) usually presents with lymphadenopathy. At the time of diagnosis, mediastinal involvement is present in most patients, and purely extranodal disease is rare. We present a case of HD with disease apparently limited to the liver and spleen, and imaging and biopsy findings compatible with sclerosing cholangitis.