Background Hematopoietic stem cell transplant (HSCT) has been increasingly used in the last few decades, with improved success in offering a cure. CNS complications are an important contributor to morbidity and mortality in HSCT patients. The aim of the study was to evaluate the role of imaging in the detection and assessment of CNSC (central nervous system complications) after HSCT in pediatric oncology patients. The study included consecutive pediatric patients who underwent HSCT for hematologic or solid malignancies at CCHE-57357 (Children Cancer Hospital–Egypt 57357) from January 2011 to March 2019. The age of the patients in the study ranged from 0.9 to 25 years (median age 6.5 years). CT (computed tomography) and/or MRI (magnetic resonance imaging) studies were evaluated for the detection and characterization of CNSC. Results The incidence of post-HSCT CNSC was 13% with a day 100 and 5-year cumulative incidence of 9.3 and 12.5%, respectively. The most commonly observed CNSC detected was disease recurrence, followed by PRES (Posterior reversible encephalopathy syndrome). CNS recurrence of the initial diagnosis, atrophy, and infection were more common at the > 100-day post-HSCT transplant period, while PRES was much more common at < 100-day post-HSCT. Conclusion CNS complications are an important contributor to morbidity and mortality in HSCT patients that require MRI protocols distinctively tailored for each patient, clinical suspicion, and proper imaging assessment for early detection and follow-up.

Background High-risk breast lesions represent 3–21% of all breast lesions and are non-obligate precursors of malignancy. Various studies have evaluated the value of DCE-MRI including DWI and ADC mapping in the detection of high-risk breast lesions, differentiating them from malignant lesions and predicting upgrade risk after surgical excision reducing misdiagnosis and overtreatment. This study is a retrospective review of all image-guided breast biopsy procedures performed in 2021 at our institution, identified 68 patients with histopathologically proven high-risk breast and available MRI examinations with no concurrent ipsilateral malignancy. Image analysis of MRI examinations included morphological criteria, enhancement pattern, dynamic curves, DWI and ADC mapping assessment. Since our knowledge of high-risk breast lesions is still growing, this study is important to evaluate the merits of DCE-MRI in the assessment of high-risk breast lesions, to allow optimization of treatment, better limit it to those women at risk, and avoid overtreatment in women at low risk. Results The mean ADC value of high-risk breast lesions was not significantly different from that of malignant breast lesions (p value = 0.015). Non-mass enhancement and type III enhancing curve proved to be significant indicators of high-risk breast lesions upgrade in surgical pathology. Cut-off average ADC value for differentiating upgraded high-risk lesions from non-upgraded high-risk lesions proved 1.24 mm2/sec with sensitivity and specificity of 94 & 100%, respectively. Discussion Management of high-risk breast lesions is important in the screening setting, as they are non-obligate precursors of malignancy, and also function as risk indicators. Frequency and upgrade rates of high-risk lesions detected by MRI provide a reference for clinical management. DCE-MRI has a high negative predictive value in predicting the upgrade risk of high-risk lesions. In this study, non-mass enhancement and type III curve were proven to be indicators of high-risk lesion upgrade. Limitations of the study included small number of patients and limited follow-up period. Conclusions The use of multi-parametric DCE-MRI including DWI and ADC mapping provides complementary information to detect high-risk breast lesions and predict their upgrade rate.

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