The medical guidelines for childhood LCH have been published in Pediatric Blood & Cancer  (PBC), Wiley Online Library.

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Head MRI in LCH Patients

Author(s): Euro Histio Net Work Group for LCH Guidelines (see introduction page), Created: 2011/03/10, last update: 2014/02/09

Technique and frequency of MRI surveillance

Technique

The MRI protocol must be able to investigate the entire brain, the hypothalamus-pituitary axis and all craniofacial bones. The aim of the MRI is to systematically seek any neuro-degenerative involvement and/or tumorous lesion and meningeal involvement. The use of intravenous contrast (Gadolinium chelates) is mandatory.

The following protocol is recommended:

  • Axial and sagittal T1 w. slices of the entire brain
  • Fine T1 w. sagittal slices focused on the pituitary gland (3 mm / 0.3 mm or below)
  • Axial T2W. and FLAIR w. slices (except age < 1 year) of the entire brain

It is not recommended to use the option “contrast by magnetic transfer”. If it is nevertheless done, the same technique has to be used every time and this information has to be specified on the report.

After injection of Gadolinium:

  • MRI scan according to data obtained on the first series by (T1 w. slices):
       Fine sagittal slices of the pituitary
       Coronal slices of the brain
  • Additional sequences may be taken if indicated.

Frequency of MRI surveillance

Suggestion for further surveillance in case of positive findings at MRI:

  1. If a lesion has been identified in the CNS it is suggested to repeat the examination after 6 weeks (in symptomatic patients and those with tumorous lesions) and 3 months. Further images should be decided on the basis of the results of the first two examinations.
  2. In case of clinical hypothalamic dysfunction or neuro degenerative findings on MRI, even without symptoms, it is suggested to perform a second MRI after one year and then at 2, 4, 7, and 10 years. If after 10 years there is no clinical deterioration, further MRI is recommended only upon clinical indication.