What is the role of imaging studies in the workup of Langerhans cell histiocytosis (LCH)?

Updated: Sep 16, 2020
  • Author: Cameron K Tebbi, MD; Chief Editor: Vikramjit S Kanwar, MBBS, MBA, MRCP(UK), FAAP  more...
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Answer

See the tables above for appropriate imaging studies when LCH is suspected.

Radiographic imaging of lytic lesions of the skull reveals a punched-out pattern without evidence of periosteal reaction or marginal sclerosis, shown below.

Radiograph of lytic lesions of the skull reveals a Radiograph of lytic lesions of the skull reveals a punched-out pattern without evidence of periosteal reaction or marginal sclerosis.

Radionuclide bone scanning with technetium-99m polyphosphate may reveal a localized increased uptake. This study is complementary to plain radiography.

MRI sometimes helps in identifying lesions that cannot be detected with other modalities. For example, in one study, 28% of children with Langerhans cell histiocytosis had MRI findings suggestive of neurodegenerative disease. [89]

Neurologic findings may not always be correlated with the MRI results and may lag behind findings on MRI. [89, 110, 233]

CT and MRI can show the detailed anatomic pattern of involvement and can help in staging the disease. [234]

Positron emission tomography (PET) with 18F-fluoro-deoxyglucose (FDG) may be an effective tool for evaluating LCH and may provide additional information regarding the activity of the lesions. [205] In a retroactive study of F-18 FDG PET/MRI scan in 16 children with LCH, PET scanning produced less false-positive results in the follow-up of patients undergoing chemotherapy compared with MRI. However, the MRI had a higher sensitivity for primary staging. [235]

In neurodegenerative LCH, F-18 FDGPET may be a useful tool for an early diagnosis before neuroradiologic abnormalities appear. [236]

With pulmonary involvement, CT scanning is the best modality to reveal cysts and micronodular infiltrates.


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