White matter changes in children treated for acute lymphoblastic leukemia.
METHODS
Twenty-seven children with acute lymphoblastic leukemia (ALL) were studied by magnetic resonance (MR) imaging after central nervous system (CNS) treatment. The children were followed by clinical evaluations and computed tomographic (CT) brain scans. Two CNS treatment techniques were used. Eleven patients received intravenous and intrathecal methotrexate; 16 patients received 18-30 Gy of cranial radiation therapy in addition to systemic chemotherapy. The time interval between the CNS treatment and MR scans varied from 9 months to 4 years 8 months.


RESULTS
Four of the 27 children (15%) showed white matter changes on the MR scans attributable to therapy, but only one had hypodensity on CT. Three of the 16 children (19%) receiving radiation therapy in addition to chemotherapy had white matter changes. One of the 11 patients (9%) from the group receiving only chemotherapy did so. The difference between the two treatment groups was not significant.


CONCLUSIONS
Radiation therapy or chemotherapy (alone or in combination) may have been responsible for the white matter changes. MR imaging is a sensitive detector of white matter changes in children with ALL, but its value and significance during follow-up should be assessed in well-designed longitudinal research studies.
Pääkkö
E
E
Department of Diagnostic Radiology, Oulu University Central Hospital, Finland.
Vainionpää
L
L
Lanning
M
M
Laitinen
J
J
Pyhtinen
J
J
D000293:Adolescent; D000328:Adult; D001921:Brain / Q000473:pathology* / Q000528:radiation effects; D001932:Brain Neoplasms / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007278:Injections, Spinal; D008279:Magnetic Resonance Imaging; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy; D011878:Radiotherapy / Q000009:adverse effects
D008727:Methotrexate