Pediatric Hematopoietic Stem Cell Transplantation and the Role of Imaging

Color Doppler US scans of the right upper quadrant in a 27-month-old girl seven weeks after hematopoietic stem cell transplantation (HSCT) for leukemia. (a, b) Reversal of flow in the main portal vein. Patient also had hepatomegaly and ascites. (c) There was also diffuse thickening (arrows) of the gallbladder wall. These findings support the clinical diagnosis of hepatic veno-occlusive disease (VOD). (Radiology 2008; 248:348–365) © RSNA, 2008. All rights reserved. Printed with permission.

Increased use of hematopoietic stem cell transplantation (HSCT) to treat children afflicted with potentially fatal and nonmalignant diseases has led not only to improved survival but also to increased risk for short- and long-term complications. HSCT requires support from many medical disciplines, including radiologists who must be familiar with the broad concepts of the procedure as well as the specific problems that can follow.

In a review article in the August issue of Radiology (RSNA.org/radiology), Caroline Hollingsworth, M.D., M.P.H., of Duke University Medical Center in Durham, N.C., and colleagues summarize the clinical aspects of HSCT, emphasizing the common complications and their imaging features:

• Early and late pulmonary
• Cardiovascular
• Musculoskeletal
• Gastrointestinal
• Hepatobiliary
• Genitourinary
• Endocrine
• Neurologic

Although parallels can be found between pediatric and adult HSCT survivors, substantive and unique differences affect the surveillance of young patients for acute and chronic problems, Dr. Hollingsworth and colleagues write. "Pediatric patients have a greater risk of developing complications because of the developing organs," they conclude. "An understanding of current HSCT treatment regimens and specific complications, especially relating to the time from treatment, typical imaging features and effect on management decisions, underscores the vital role radiologists serve in this complex lifesaving therapeutic modality."

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Read BIROW 5 Report in Radiology

The final report of the fifth annual Bioengineering and Imaging Research Opportunities Workshop (BIROW 5) is in the August issue of Radiology. Encompassing more than 25 scientific societies, BIROW meetings facilitate the mission of the National Institute of Biomedical Imaging and Bioengineering by encouraging cross-fertilization of ideas and interdisciplinary science.

The BIROW 5 report addresses research opportunities in imaging and characterizing structure and function in native and engineered tissue, outlining goals and challenges in these areas:

• Heterogeneous single cell measurements and their integration into tissue and organism models
• Functional molecular and structural imaging of engineered tissue in vitro and in vivo
• New technologies for characterizing cells and tissues in situ
• Imaging for targeted cell, gene and drug delivery

Cholangiocarcinoma (CCA) with intraductal polypoid growth pattern. Axial contrast-enhanced CT scan shows a polypoid soft-tissue mass (arrow) within the dilated common bile duct.	Periductal-infiltrating type of CCA. Axial delayed gadolinium-enhanced fat-saturated 3D gradient-echo T1-weighted MR image shows a periductal, infiltrative pattern of tumor growth (black arrowheads) with associated biliary dilatation (white arrowheads). (RadioGraphics 2008;28:1115–1129) © RSNA, 2008. All rights reserved. Printed with permission.

Diagnosis and treatment of cholangiocarcinoma (CCA)—the second most common primary malignant hepatobiliary neoplasm, accounting for approximately 15 percent of liver cancers—are challenging, as numerous other conditions of the biliary tract may masquerade as CCA.

In an article in the July-August issue of RadioGraphics (RSNA.org/radiographics), Christine O. Menias, M.D., of the Mallinckrodt Institute of Radiology in St. Louis, and colleagues discuss the cross-sectional imaging findings of a spectrum of neoplastic and nonneoplastic biliary lesions that mimic CCA at imaging, including:

• Inflammatory or infectious biliary conditions: primary and secondary sclerosing cholangitis

• Hepatobiliary tumors: hepatocellular carcinoma, intrabiliary metastases, biliary tract melanoma and lymphoma, leukemic involvement or carcinoid tumors of the bile ducts

"Precise differentiation of various inflammatory or neoplastic biliary disorders from the more ominous cholangiocarcinoma allows optimal patient treatment," the authors write.

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