BACKGROUND: Children treated with cranial radiotherapy (CRT) for leukemia are at 
risk of developing central nervous system injuries. Magnetic resonance imaging 
(MRI) represents the examination method of choice for evaluating 
radiation-induced brain complications. The purpose of this report is to describe 
the spectrum of MRI abnormalities detected in a group of survivors of leukemia 
treated with cranial irradiation.
PROCEDURES: In this cross-sectional, single center study, 56 patients (median 
age at follow-up 19 years) receiving CRT as cranial prophylaxis (CP) included in 
the leukemia protocol (total dose 1,800-2,400 cGy) and/or in the total body 
irradiation regimen (990-1,200 cGy) before hematopoietic stem cell transplant, 
were evaluated by MRI after a median interval of 11 years (range 2-27) following 
CRT.
RESULTS: Fifty-nine MRI abnormalities (32 cavernomas, nine focal areas of 
gliosis, seven dystrophic mineralizations, five cerebral atrophies, four 
pituitary atrophies, one diffuse radiation leukoencephalopathy, and one 
meningioma) were found in 43 patients. The longest interval between CRT and MRI 
and oldest age at follow-up represented the two risk factors that were 
statistically associated with MRI lesions (P = 0.032 and 0.033, respectively). 
Cerebral cavernomas (CC) were the most frequent MRI abnormalities (57%). All 
patients with CC were asymptomatic at diagnosis and during follow-up, except one 
who had aspecific neurological manifestations and micro hemorrhages.
CONCLUSIONS: These results confirm that total doses and modalities of 
fractionation dose of CRT were not significantly associated with MRI 
abnormalities. Moreover, in our experience none of the patients developed 
neurological symptoms related to MRI abnormalities, and furthermore, the CC 
remained substantially stable during follow-up.