Brain imaging findings in symptomatic patients after allogeneic haematopoietic stem cell transplantation: correlation with clinical outcome

To investigate the risk factors for, and the incidence of, structural abnormalities on brain imaging in allogeneic haematopoietic stem cell transplant (HSCT) patients, and correlate these findings with survival.

We retrospectively reviewed all brain computed tomography (CT) and/or magnetic resonance imaging (MRI) studies obtained during the first post-HSCT year from 2004 thru 2007 in allogeneic HSCT recipients.

A total of 128 patients had brain imaging in the first post-HSCT year. Forty one of these 128 patients (32 %) had structural abnormalities on brain imaging: cerebrovascular complications (n = 10), central nervous system (CNS) infection (n = 9), subdural fluid collection (n = 6), CNS recurrence of haematological malignancy (n = 11), and drug toxicity abnormalities (n = 5). The only significant risk factor for structural imaging abnormality was younger patient age (P = 0.01). MRI was significantly more likely than CT to provide specific imaging diagnosis of cerebral lesions (P = 0.001). HSCT patients with cerebrovascular complications have poor survival (P < 0.05). However, overall survival was not significantly worse for the 41 patients with the structural imaging abnormalities as compared to the 87 patients who had brain imaging but no structural abnormalities.

There was no survival difference in patients whose brain imaging was normal or abnormal. However, there was poor outcome in patients with cerebrovascular complications after HSCT.