The 1st MRI shows features of retinal hemorrhage with leukemic infiltration of the left optic nerve in a patient with an acute lymphoblastic leukemia (ALL).

The 2nd MRI (performed 9 months later) shows progression of the orbital involvement with extension to the contralateral orbit, and appearance of a tumoral process at the opto-chiasmatic region highly suggestive of bilateral optic nerves/opto-chiasmatic gliomas.

Orbital involvement is the result of an infiltration of soft tissue or orbital bone, usually seen up to 75%  of acute lymphoblastic leukemia (ALL), and up to 20% of acute myeloid leukemia (AML). MRI is more sensitive than CT in the detection of blood and blood products within the globe.

Tumoral processes such as meningioma, glioma and sarcoma are usually seen after radiation-therapy (radiation-induced neoplasms), however, they are also described in patients who have not received radiation-therapy ¹ (as in this case).

Additional contributor: R. Bouguelaa, MD