儿童早期甲氨蝶呤相关神经毒性的扩散加权磁共振成像
Diffusion-weighted MR imaging of early methotrexate-related neurotoxicity in children.
作者信息
Fisher Michael J, Khademian Zarir P, Simon Erin M, Zimmerman Robert A, Bilaniuk Larissa T
机构信息
Division of Neuroradiology, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
出版信息
AJNR Am J Neuroradiol. 2005 Aug;26(7):1686-9.
BACKGROUND AND PURPOSE
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.
CONCLUSION
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.
背景与目的
甲氨蝶呤是血液系统恶性肿瘤患儿治疗相关急性神经毒性的主要原因。本研究旨在探讨弥散加权磁共振成像（DWI）能否检测出该患者群体中甲氨蝶呤所致的急性白质神经毒性。
方法
对6例血液系统恶性肿瘤患儿（3例女性，3例男性）进行研究，研究时间为治疗延迟强化或巩固阶段出现神经功能障碍时，此时给予鞘内注射大剂量甲氨蝶呤。在1.5T磁共振扫描仪上进行包括DWI在内的磁共振成像检查。
结果
6例患者的DWI均显示半卵圆中心水的运动受限异常。这一发现与偏瘫或失语的急性发作相关。此时液体衰减反转恢复成像未呈阳性，但在进行随访成像的所有5例患者中呈阳性。
结论
通过DWI早期检测甲氨蝶呤所致的白质损伤，有可能提醒肿瘤学家注意这一情况，并提供一种可监测神经毒性治疗的技术。
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