L-asparaginase therapy with concomitant cranial venous thrombosis: can MRI help avoiding stroke.

PURPOSE To prospectively use MRI in the early detection of intracranial sino-venous thrombosis during the L-asparaginase induction therapy of acute leukemia thus preventing the evolution of brain venous infarct. MATERIAL AND METHODS The study population consisted of seventy patients receiving L-asparaginase induction therapy for acute leukemia in the National Cancer Institute of Cairo University presenting with clinical neurological signs suggestive of aseptic intracranial venous thrombosis. All the patients were studied by 1.5 Tesla magnet using conventional MRI pulse sequences and MR venographic studies. The imaging findings were processed as regards the detection of venous thrombosis, its signal criteria and the evaluation of any companion brain parenchymal ischemic insults. RESULTS Eleven patients were diagnosed with dural venous sinus thrombosis with subsequent specific signal pattern of the thrombus that could be linked to the duration of thrombosis. The MR venographic studies detected the thrombosis in nine cases out of eleven. Ten cases scored brain parenchymal signal abnormality that could indicate infarction, eight of them were hemorrhagic in nature. CONCLUSION L-asparaginase therapy is accompanied by high risk of venous thrombosis that could involve the intra-cranial sino-venous structures. MRI could be used effectively in the early diagnosis of such serious, curable complication using a combination of conventional spin echo pulse sequences and MR venographic studies. Hemorrhagic venous infarcts should draw the attention to underlying established venous thrombosis. KEY WORDS Asparaginase - Venous thrombosis-MRI.