Pääkkö E, Harila-Saari A, Vanionpää L, Himanen S, Pyhtinen J, Lanning M
Department of Diagnostic Radiology, University of Oulu, Oulu, Finland.
Med Pediatr Oncol. 2000 Nov;35(5):456-61. doi: 10.1002/1096-911x(20001101)35:5<456::aid-mpo3>3.0.co;2-1.
Treatment of childhood acute lymphoblastic leukemia (ALL) may cause structural and functional brain damage. To find out the incidence of white matter changes during therapy, a prospective MRI study was designed, and the findings were correlated with neuropsychological evaluation.
Thirty-three children with ALL underwent serial cranial MRI before, during, and after therapy. Twenty-eight of these children underwent also neuropsychological assessment at the end of treatment. They all received intravenous and intrathecal methotrexate for central nervous system (CNS) therapy, 15 patients received cranial irradiation in addition.
Transient high-intensity white matter changes were observed by MRI in three children 9% (95% CI, 2-24%) who received chemotherapy only. The high-intensity changes were most prominent in the frontal lobes in two of these children. The children with white matter changes were significantly younger than those with normal MRI (2.8 vs. 7.4 years; mean). There was no correlation between neuropsychological tests and white matter changes, except in attention and in tests referring to the frontal areas in general.
White matter changes are occasionally observed during therapy with the current Nordic protocols. Young children may be more susceptible to developing white matter changes after repeated intravenous methotrexate injections. There is no systematic correlation between neuropsychological deficits and MRI findings.
儿童急性淋巴细胞白血病（ALL）的治疗可能会导致脑部结构和功能损伤。为了明确治疗期间白质变化的发生率，设计了一项前瞻性MRI研究，并将研究结果与神经心理学评估相关联。
33例ALL患儿在治疗前、治疗期间和治疗后接受了系列头颅MRI检查。其中28例患儿在治疗结束时还接受了神经心理学评估。他们均接受了静脉和鞘内注射甲氨蝶呤进行中枢神经系统（CNS）治疗，15例患者还接受了颅脑照射。
仅接受化疗的3例患儿（9%，95%CI：2%-24%）通过MRI观察到短暂性高强度白质变化。其中2例患儿的高强度变化在额叶最为明显。白质发生变化的患儿明显比MRI正常的患儿年龄小（平均2.8岁对7.4岁）。除了注意力和一般涉及额叶区域的测试外，神经心理学测试与白质变化之间没有相关性。
按照当前北欧方案进行治疗期间偶尔会观察到白质变化。幼儿在反复静脉注射甲氨蝶呤后可能更容易发生白质变化。神经心理学缺陷与MRI结果之间没有系统性关联。
