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Acute lymphoblastic leukemia (ALL)

Case contributed by Dr Maxime St-Amant

Presentation

Hematologic abnormalities.

Patient Data

Age: 15 years
Gender: Male

MRI shows diffusely hypointense T1 vertebrae with multiple vertebral fractures. At some levels, there is retropulsion of the fractures which compresses the thecal sac, without significant spinal stenosis or radicular compression.

There is hepatomegaly (>15 cm cephalocaudal) and splenomegaly (>13 cm cephalocaudal). No lymphadenopathy, however.

Case Discussion

Acute lymphoblastic leukemia was confirmed in this patient after a bone marrow biopsy. It is the most common leukemia in childhood. Characteristically, the vertebral bodies are diffusely T1-hypointense and T2/STIR-hyperintense due to leukemic infiltrates replacing the normal fatty marrow. Pathologic fractures are frequently seen and can mimic non-accidental trauma.

With these types of MR signals, multiple vertebral fractures, and hepatosplenomegaly, there is no significant differential diagnosis worth mentioning except for other types of leukemia.

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