Imaging Characterization of Central Nervous System Affection in Hematological Malignancies Patients

Background Central nervous system (CNS) complications in patients with hematological malignancies pose significant diagnostic and therapeutic challenges. Magnetic resonance imaging (MRI), with its various sequences, plays a pivotal role in early diagnosis, characterization, and differentiation of these conditions to guide management and improve outcomes. Objective This research aimed to assess the diagnostic performance and utility of different MRI sequences (conventional, diffusion-weighted imaging (DWI), and apparent diffusion coefficient (ADC) mapping) in detecting and differentiating CNS complications in patients with hematological malignancies presenting with neurological manifestations. Methods A retrospective cohort of 130 patients (age range 2–81 years; 60% male and 40% female) with histopathologically confirmed hematological malignancies and neurological symptoms underwent comprehensive brain MRI. MRI protocols included T1, T2-weighted imaging, FLAIR, DWI with ADC mapping, susceptibility images(SWI) and post-contrast T1-weighted imaging. Results The study population comprised leukemia (38.5%), lymphoma (38.5%), multiple myeloma (15.4%), and Langerhans cell histiocytosis (7.7%). At the time of MRI, 48.5% of patients were undergoing induction therapy, 38% maintenance, and 13.5% consolidation. MRI findings were varied: cerebral venous sinus thrombosis (CVST) was the most frequent abnormality (33%), followed by CNS infiltration (27%) and posterior reversible encephalopathy syndrome (PRES) (17%). Additional findings included methotrexate toxicity (9%), CNS infections (5%), hemorrhage (3%), post-radiotherapy changes (2%), leukoencephalopathy (2%), and brain atrophy (2%). PRES lesions predominantly occurred during induction (73%), most frequently affecting the occipital lobes (90%) with bilateral involvement in nearly all cases. CVST primarily involved the superior sagittal sinus (76%) and was most common during maintenance (54.7%) and induction (38%) phases. CNS infiltration was observed in multiple sites including retina (20.6%), cerebral parenchyma (26.5%), meninges (14.7%), and skull/maxillofacial bones (20.6%). Methotrexate toxicity presented as symmetric diffusion restriction in periventricular white matter without corresponding abnormalities on conventional sequences. Conclusions Multimodal MRI combining conventional, diffusion, and contrast-enhanced sequences is essential for accurate diagnosis and differentiation of CNS complications in hematological malignancies. This approach facilitates timely clinical decision-making by distinguishing infiltration, infection, therapy-related toxicity, and vascular abnormalities, ultimately improving patient management and outcomes.