title: Diffusion-weighted MR imaging of early methotrexate-related neurotoxicity in children.
abstract: OBJECTIVE
  Methotrexate is a major cause of treatment-related acute neurotoxicity in children with hematologic malignancies. The purpose of this study was to investigate whether diffusion-weighted MR imaging (DWI) detects acute methotrexate white matter neurotoxicity in this patient population.
  
  
  METHODS
  Six children-three female and three male-with hematologic malignancies were studied at time of onset of neurologic dysfunction during the delayed intensification or consolidation phase of therapy, when intensive intrathecal methotrexate is given. MR imaging including DWI was performed on 1.5 T MR scanners.
  
  
  RESULTS
  DWI demonstrated abnormal restriction of motion of water in the centrum semiovale in all six patients. This finding correlated to the acute onset of hemiparesis or aphasia. Fluid-attenuated inversion recovery imaging was not positive at this time, but it was positive in all five patients in whom follow-up imaging was performed.
  
  
  CONCLUSIONS
  Early detection of methotrexate white matter injury by DWI has the potential to alert the oncologist to this event and provide a technique by which treatment of neurotoxicity can be monitored.
authors.affiliation: Division of Neuroradiology, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Fisher
authors.forename: Zarir P
authors.initials: ZP
authors.lastname: Khademian
authors.forename: Erin M
authors.initials: EM
authors.lastname: Simon
authors.forename: Robert A
authors.initials: RA
authors.lastname: Zimmerman
authors.forename: Larissa T
authors.initials: LT
authors.lastname: Bilaniuk
mesh_terms: D000293:Adolescent; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects* / Q000627:therapeutic use; D001037:Aphasia / Q000209:etiology; D001921:Brain / Q000473:pathology*; D001927:Brain Diseases / Q000139:chemically induced* / Q000175:diagnosis*; D002648:Child; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D005500:Follow-Up Studies; D019337:Hematologic Neoplasms / Q000150:complications / Q000188:drug therapy / Q000523:psychology; D006429:Hemiplegia / Q000209:etiology; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000009:adverse effects* / Q000627:therapeutic use; D009498:Neurotoxins
chemical_list: D000964:Antimetabolites, Antineoplastic; D009498:Neurotoxins; D008727:Methotrexate