CT and MRI manifestations of anterior mediastinal T lymphoblastic lymphoma/acute lymphoblastic leukemia in children

WANG Xiaoyu; LIN Huihui; HU Jun; ZHU Xiaodong; LI Xu

doi:10.19300/j.2026.L22578

Abstract：Objective To analyze the CT and MRI manifestations of anterior mediastinal T-lymphoblastic lymphoma/acute lymphoblastic leukemia(T-LBL/ALL)in children.Methods The clinical data of 23 children with pathologically confirmed anterior mediastinal T-LBL/ALL were retrospectively collected.All patients underwent plain and contrast-enhanced CT scans prior to chemotherapy,and 4 cases additionally underwent plain and contrast-enhanced MRI examinations.Independent-sample t-test and Fisher's exact test were employed to compare CT findings between T-LBL and T-ALL.The CT manifestations of all patients and the MRI features of the 4 cases were analyzed.Results All of 23 tumors were in mass form(100%)and had a large volume.Among them,22 cases(95.7%)had well-defined margins,7 cases(30.4%)were uniformly solid in density,and 16 cases(69.6%)exhibited cystic-solid components.After contrast enhancement,the solid components of the 23 tumors showed mild-to-moderate progressive enhancement with small intratumoral vessels traversing the lesions.The majority of patients showed marked mass effect on imaging.Most had compression of mediastinal large vessels(20 cases,87.0%)and airways compression(19 cases,82.6%).Pericardial and pleural effusions(20 cases,87.0%)and pleural thickening(13 cases,56.5%)were observed.A small number of patients developed venous thrombosis(1 case,4.3%)and renal metastasis(8 cases,34.8%).Cystic degeneration and necrosis were more likely to occur in T-LBL than in T-ALL(P=0.027).Conclusion The CT and MRI imaging manifestations of T-LBL/ALL in the anterior mediastinum of children have certain characteristics,and imaging follow-up can effectively evaluate the treatment effect and the progression of complications.