Central nervous system disease in adults with hematopoietic malignancies. A study of intraventricular prophylaxis and treatment

This thesis deals with the CNS involvement in some hematopoietic malignancies such as ALL, AML and high grade malignant NHL. The study concerns adult patients. Attention is focused upon prevention of this complication and also upon the treatment possibilities, once dissemination has occurred. For better understanding an overview of historic facts, pathogenesis and subsequent clinical findings is given in the first chapter. Early meningeal dissemination can go undetected, certainly if no thorough surveillance of the CSF is undertaken. The difficulties in diagnosing ML and MenLy, the options available for CNS prophylaxis and treatment of meningeal disease along with the attached neurotoxicities are described. ... Zie: Summary.

Normal Cerebrospinal Fluid Dynamics:A Study With Intraventricular Injection of 111In-DTPA in Leukemia and Lymphoma Without Meningeal Involvement

The cerebrospinal fluid flow pattern in seven patients with leukemia or lymphoma, but without prior meningeal or cerebral disease, was studied following introduction of indium-diethylenetriamine pentaacetic acid In-DTPA 111 in a lateral ventricle through an Ommaya reservoir. The time to egress from the ventricular system into the basal cisterns was variable but generally short. One hour after administration, the basal cisterns were clearly visible in all patients. Thereafter, kinetics throughout the cranial and spinal subarachnoid space were consistent. The flow patterns of three patients cured of meningeal dissemination and one patient with mild meningeal leukemia were similar to the normal pattern

Evaluation of dissemination studies with FDG whole-body positron emission tomography in patients with suspected metastatic tumours of brain and spine

Background. In the preoperative diagnosis of malignant brain tumours there is often uncertainty regarding their metastatic or primary nature, requiring dissemination studies. Currently FDG-wbPET is being used for the efficient detection of systemic tumours. It therefore may become a substitute for the conventional dissemination studies if it allows an earlier diagnosis. Method. In this descriptive and preliminary study a population of 14 patients with suspected or proven metastatic lesions, [18F]-fluoro-2-deoxy-D-glucose whole body positron emission tomography (FDG-wbPET) was conducted and verified by additional conventional dissemination studies. Findings and their Interpretation. The entire series of dissemination studies required an average of 30 days with a range of 4-73 days. The FDG-wbPET was corroborated by the other dissemination studies in 10 of the 14 patients. In 7 of these 10 patients both PET and dissemination studies showed systemic abnormal findings, but in one case the presence of high pulmonary activity on the FDG-wbPET and the abnormal findings on the chest X-rays proved to be Aspergillus infection at autopsy. In the other 2 cases the negative PET findings corresponded to the absence of systemic dissemination. In 5 cases there was disagreement of the results of the FDG-wbPET with other evidence, among which there were 2 cases of glioblastoma in which systemic metastases were most unlikely, and the foci of activity on the FDG-wbPET had to be considered as false positives. In the remaining 3 cases the systemic presence of high activity on the FDG-wbPET indicated the systemic presence of tumour, whereas the other dissemination studies disclosed no tumour. Conclusion. The results warrant the use of FDG-wbPET as a screening method for the search of metastases, allowing other studies to be focussed on the lesion. But from the cost/benefit point of view this would make the method less suitable as a substitute for dissemination studies in general, although it may speed up the diagnostic process