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After treatment and remission

When imaging is needed

Unlike many solid tumours, leukaemia remission is monitored mainly with blood tests. Sometimes, though, an echocardiogram, CT, MRI or bone density scan is needed. This topic explains when and why they are done.

Last updated: ~3 min read
An echocardiogram shows the heart working, without radiation
Figure 1.An echocardiogram shows the heart working, without radiation.

01Short answer

Leukaemia is a disease of the blood and bone marrow, so the main way to monitor remission is blood tests and, when needed, bone marrow tests; routine CT or PET is not needed for everyone. Imaging is done when there is a specific question: an echocardiogram after medicines that can affect the heart (anthracyclines), a bone density scan (DXA) after long-term steroids or a transplant, MRI for joint pain when bone death (avascular necrosis) is suspected, and X-ray, ultrasound or CT for infections or other symptoms. In some lymphoid leukaemias (for example CLL) CT may be used to assess lymph nodes. Your doctor decides which test is needed based on your treatment and symptoms.

02Simple explanation

In leukaemia the main monitoring is blood tests.

Imaging is needed when there is a specific question.

For the heart — echocardiography.

For bones — DXA or MRI.

Your doctor makes the choice.

03Scientific explanation

Heart: the COG long-term follow-up guidelines recommend regular echocardiograms for people who received anthracyclines or chest radiation, with frequency depending on dose and age.

Bone density: long-term corticosteroids, transplant and hormone changes raise the risk of osteoporosis; DXA measures it with a low radiation dose (MedlinePlus).

Avascular necrosis: especially after steroids, the blood supply to the hip and knee bones can be disrupted; MRI is the most sensitive method at an early stage.

Radiation dose: MedlinePlus notes that CT gives more radiation than an X-ray, so repeat CT is ordered only when the benefit outweighs the risk.

04What happens in the body?

Why is routine CT not needed?

Leukaemia cells are in the blood and bone marrow, so they usually cannot be “seen” on a scan. Blood tests, marrow and molecular tests show the state of remission more accurately.

Checking the heart

Some chemotherapy medicines can affect the heart muscle years later. An echocardiogram is an ultrasound test with no radiation that shows how well the heart pumps.

When is CT needed?

Your doctor may order CT for a persistent cough, a suspected lung infection, abdominal pain or enlarged lymph nodes. In some leukaemias, such as CLL, CT helps assess the extent of the disease.

An empty, softly lit CT ring in a calm dark room.
Figure 2.CT is ordered when there is a specific question.

Bone health

Steroids and transplant can weaken bones. DXA measures bone density, and MRI detects avascular necrosis early when there is hip or knee pain.

A clear hip bone with its inner honeycomb glowing gold.
Figure 3.Bone density and health are checked by imaging.

Other tests

Abdominal ultrasound checks the liver and spleen simply and quickly, and a chest X-ray checks the lungs. People treated in childhood may be advised to have a thyroid ultrasound.

Preparing for a scan

Tell your doctor in advance about any contrast allergy, kidney problems, metal implants or possible pregnancy. Bring earlier images with you — they are important for comparison.

05From question to result

The steps of imaging.

Question — First there is a specific medical question.1QuestionFirst there is a specific medical question.
Choice — The method is chosen to fit the question.2ChoiceThe method is chosen to fit the question.
Review — A radiologist reports on the images.3ReviewA radiologist reports on the images.
Plan — The result is added to the follow-up plan.4PlanThe result is added to the follow-up plan.
PurposeEvery scan has a reason.
Less radiationUnneeded scans are avoided.
A clear planThe result is added to follow-up.

06Tests and typical reasons (simplified)

TestWhat it checksTypical reason
EchocardiogramHeart functionAnthracyclines, chest radiation
DXABone densitySteroids, transplant
MRIJoints, brainPain, neurological symptoms
CTLungs, abdomen, lymph nodesInfection, symptoms, CLL
UltrasoundLiver, spleen, thyroidSymptoms, long-term follow-up

* The table is an example; every plan is individual.

07Key terms

Echocardiogram
An ultrasound scan of the heart.
CT
Computed tomography — cross-section images made with X-rays.
MRI
Images made with a magnetic field; no radiation.
DXA
A low-dose test that measures bone density.
Avascular necrosis
Damage to bone tissue because its blood supply is disrupted.
Contrast
A substance that makes images clearer.

08Key points

  • In leukaemia the main monitoring is blood tests.
  • Imaging is for a specific question.
  • The heart is checked after anthracyclines.
  • Bones are checked after steroids.
  • Unneeded CT adds radiation.
  • Keep your earlier images.

09Frequently asked questions

I am in remission — should I have a PET-CT?

In leukaemia this is usually not needed routinely. If your doctor sees a specific reason, they will order it.

Is MRI dangerous?

MRI uses no radiation. Tell staff in advance if you have a metal implant or pacemaker.

How often should I have an echocardiogram?

It depends on the medicine dose, your age and your heart; your doctor sets the schedule.

My hip hurts — is it just tiredness?

After steroids, persistent hip pain should be reported to your doctor; an MRI may be needed.

Where do I get my images?

Ask the centre where the scan was done for a disc or digital copy, and keep it with the report.

10Questions for your doctor

Take these questions to your appointment. The ones you save are collected on the “My questions” page and stay on this device only.

  1. I am in remission — should I have a PET-CT?

  2. Is MRI dangerous?

  3. How often should I have an echocardiogram?

  4. My hip hurts — is it just tiredness?

  5. Where do I get my images?

My questions

12Sources

  1. National Cancer Institute (NCI). Follow-Up Medical Care
  2. Children's Oncology Group. Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent and Young Adult Cancers
  3. MedlinePlus (U.S. National Library of Medicine). Echocardiogram
  4. MedlinePlus (U.S. National Library of Medicine). CT scan
  5. MedlinePlus (U.S. National Library of Medicine). Bone mineral density test
  6. MedlinePlus (U.S. National Library of Medicine). MRI
  7. Annals of Oncology, 2020. Heuser M et al. Acute myeloid leukaemia in adult patients: ESMO Clinical Practice Guidelines
  8. American Cancer Society. Living as an Acute Myeloid Leukemia (AML) Survivor
  9. National Cancer Institute. Facing Forward: Life After Cancer Treatment
  10. National Cancer Institute. Coping: survivorship
Medical disclaimerThis information is for educational purposes only and does not replace medical advice.
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