Brain perfusion after treatment of childhood acute lymphoblastic leukemia.
Children with acute lymphoblastic leukemia (ALL) have impairment in their neuropsychological functioning and morphological changes in their brain after cranial irradiation and chemotherapy. The aim of this study was to identify possible brain perfusion defects caused by different types of treatment and their association with abnormalities in cerebral MRI and neuropsychological and clinical neurological findings.


METHODS
Twenty-five consecutive children with ALL at the cessation of chemotherapy or after 1 yr were included. All of the children were given intravenous and intrathecal methotrexate for central nervous system therapy, 13 of them received cranial radiation therapy. Brain SPECT, cerebral MRI, clinical neurological and neuropsychological evaluations were performed.


RESULTS
Eleven of the 25 patients (44%) had brain perfusion defects in SPECT, eight of whom were treated with chemotherapy alone, and three received cranial irradiation. Two patients had small bilateral white matter changes on MRI; their brain SPECT scans were abnormal, although the findings were not related. Impairment of neuropsychological functioning was found in 86% of the patients tested. No significant difference between the patients with abnormal and normal SPECT were found. Those patients with abnormal SPECT were younger than those with normal SPECT and had received more frequent intravenous methotrexate infusions.


CONCLUSIONS
Brain SPECT detected perfusion defects that had occurred after treatment for childhood ALL. These defects may be related to frequent administration of a combination of intravenous and intrathecal methotrexate and/or young age.
Harila-Saari
A H
AH
Department of Pediatrics, Oulu University Central Hospital, Finland.
Ahonen
A K
AK
Vainionpää
L K
LK
Pääkkö
E L
EL
Pyhtinen
J
J
Himanen
A S
AS
Torniainen
P J
PJ
Lanning
B M
BM
D000293:Adolescent; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects; D001921:Brain / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000187:drug effects / Q000528:radiation effects; D002648:Child; D002675:Child, Preschool; D016371:Cranial Irradiation / Q000009:adverse effects; D003545:Cysteine / Q000031:analogs & derivatives*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects; D009460:Neurologic Examination; D015609:Organotechnetium Compounds; D010091:Oximes; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000532:radiotherapy; D019690:Technetium Tc 99m Exametazime; D015899:Tomography, Emission-Computed, Single-Photon
D000964:Antimetabolites, Antineoplastic; D015609:Organotechnetium Compounds; D010091:Oximes; D019690:Technetium Tc 99m Exametazime; C059659:technetium Tc 99m bicisate; D003545:Cysteine; D008727:Methotrexate