Central Nervous System Involvement in Acute Myeloid Leukemia: From Pathophysiology to Neuroradiologic Features and the Emerging Role of Artificial Intelligence.

Background/Objectives: Central nervous system (CNS) involvement in acute myeloid leukemia (AML) is a rare but important complication linked to poor outcomes. Diagnosing it is difficult because neurological symptoms are often subtle or nonspecific, and conventional cytology and imaging have limitations. This review summarizes current evidence on the neuroradiologic features of CNS infiltration in AML and explores the growing role of artificial intelligence (AI) in enhancing detection and characterization. Methods: A thorough narrative review was conducted using PubMed, Scopus, and Embase, employing key terms related to AML, CNS involvement, MRI, CT, PET, AI, machine learning, deep learning, and radiomics. Of several thousand records, 138 relevant studies were selected and analyzed across four main areas: neuroradiologic patterns, imaging biomarkers, AI and radiomics applications, and emerging computational trends. Results: Imaging findings in AML mainly include myeloid sarcomas (isointense on T1, hyperintense on T2/FLAIR, restricted diffusion) and leptomeningeal enhancement. Secondary ischemic or hemorrhagic lesions may indicate brain leukocytosis. MRI proved more sensitive than CT, while PET/CT helped detect extramedullary disease. Recent AI and radiomics models showed high tumor classification and prognosis accuracy in similar CNS conditions, indicating significant potential for application in AML-CNS. Conclusions: Combining AI-based image analysis with multimodal neuroimaging could significantly improve diagnostic accuracy and personalized treatment for CNS involvement in AML. Progress is still challenged by the rarity of the condition and the lack of large, annotated datasets.