Frontiers in oncology · 2026
Early imaging differentiation of children with acute hematologic malignancies that present in pancytopenia: a retrospective study.
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Ma Junya, Wang Ye, Xu Ye, He Yu, Zhang Xinyu, Li Jun, Gao Sijie, Ma Wei, Dai Dajian
Аннотация
OBJECTIVES: This retrospective cohort study aimed to identify potential differentiation indicators on thoracic and abdominal computed tomography (CT) among three hematologic malignancies characterized by acute pancytopenia in children.
METHODS: This study was conducted at the Children's Hospital of Chongqing Medical University, Chongqing, China. A total of 133 children with acute pancytopenia from August 2016 to November 2024 were enrolled, including 23 with malignancy-associated hemophagocytic lymphohistiocytosis (M-HLH), 58 with acute leukemia (AL), and 52 with Epstein-Barr virus-associated HLH (EBV-HLH). The differences in thoracic and abdominal CT features were statistically analyzed.
RESULTS: Chest CT showed significant intergroup differences in pulmonary lesions, thickening of the bronchiovascular bundle, and pleural effusion. Mediastinal largest lymph nodes (LLNs) in M-HLH were significantly larger, with receiver operating characteristic (ROC)-derived cutoff values of 11.45 mm (M-HLH vs. AL, sensitivity 65.2%, specificity 98.2%) and 11.60 mm (M-HLH vs. EBV-HLH, sensitivity 65.2%, specificity 100%), predominantly located in the retroinnominate space. Abdominal CT revealed significant differences in widened periportal space, ascites, splenomegaly, and intrarenal lesions. Abdominal LLNs in M-HLH were larger, with cutoff values of 9.3 mm (M-HLH vs. AL, sensitivity 72.7%, specificity 77.2%) and 9.60 mm (M-HLH vs. EBV-HLH, sensitivity 72.7%, specificity 75.0%).
CONCLUSIONS: Thoracic and abdominal CT manifestations are usually different among pediatric hematologic malignancies that present in acute pancytopenia, providing valuable supportive clues for differential diagnosis.
METHODS: This study was conducted at the Children's Hospital of Chongqing Medical University, Chongqing, China. A total of 133 children with acute pancytopenia from August 2016 to November 2024 were enrolled, including 23 with malignancy-associated hemophagocytic lymphohistiocytosis (M-HLH), 58 with acute leukemia (AL), and 52 with Epstein-Barr virus-associated HLH (EBV-HLH). The differences in thoracic and abdominal CT features were statistically analyzed.
RESULTS: Chest CT showed significant intergroup differences in pulmonary lesions, thickening of the bronchiovascular bundle, and pleural effusion. Mediastinal largest lymph nodes (LLNs) in M-HLH were significantly larger, with receiver operating characteristic (ROC)-derived cutoff values of 11.45 mm (M-HLH vs. AL, sensitivity 65.2%, specificity 98.2%) and 11.60 mm (M-HLH vs. EBV-HLH, sensitivity 65.2%, specificity 100%), predominantly located in the retroinnominate space. Abdominal CT revealed significant differences in widened periportal space, ascites, splenomegaly, and intrarenal lesions. Abdominal LLNs in M-HLH were larger, with cutoff values of 9.3 mm (M-HLH vs. AL, sensitivity 72.7%, specificity 77.2%) and 9.60 mm (M-HLH vs. EBV-HLH, sensitivity 72.7%, specificity 75.0%).
CONCLUSIONS: Thoracic and abdominal CT manifestations are usually different among pediatric hematologic malignancies that present in acute pancytopenia, providing valuable supportive clues for differential diagnosis.