Yoshida Shoko, Hayakawa Katsumi, Yamamoto Akira, Kuroda Hiroshi, Imashuku Shinsaku
Department of Radiology, Kyoto City Hospital, 1-2 Higashi Takada-cho, Mibu, Nakagyo-ku, Kyoto, 604-8845, Japan.
Eur Radiol. 2008 Oct;18(10):2048-59. doi: 10.1007/s00330-008-1000-3. Epub 2008 May 20.
Bone marrow transplantation (BMT) is widely performed for both neoplastic and non-neoplastic disease. Before BMT, patients are prepared with high-dose chemotherapy, frequently associated with total-body radiation, to destroy residual malignant cells and to reduce immunologic resistance. BMT is associated with several central nervous system (CNS) complications secondary to underlying disease, prolonged myelosuppression, and the use of immunosuppressive drugs. These complications include infections, vascular disease, drug-induced neurotoxicity, metabolic disturbance, and post-BMT carcinogenesis. The immune status of children after BMT can be divided into three phases: the pre-engraftment period (days 0-30 after BMT), the post-engraftment period (days 30-100), and the late phase (after day 100). The timing of CNS complications that occur after BMT, as for complications in other organs, can be described with reference to these three phases of immune status. It is essential that radiologists become familiar with the relationships between the immune status of the recipient and the times of onset of these disorders, and with the neuroimaging patterns associated with the various complications. CNS complications can be life-threatening for immunosuppressed children, so accurate diagnosis is important for prompt and appropriate treatment.
骨髓移植（BMT）广泛应用于治疗肿瘤性疾病和非肿瘤性疾病。在进行BMT之前，患者要接受大剂量化疗，通常还会进行全身放疗，以消灭残留的恶性细胞并降低免疫抵抗。BMT会引发多种中枢神经系统（CNS）并发症，这些并发症继发于基础疾病、长期骨髓抑制以及免疫抑制药物的使用。这些并发症包括感染、血管疾病、药物性神经毒性、代谢紊乱以及BMT后致癌。BMT后儿童的免疫状态可分为三个阶段：植入前期（BMT后0至30天）、植入后期（30至100天）和后期（100天之后）。与其他器官的并发症一样，BMT后发生的CNS并发症的时间可以参照这三个免疫状态阶段来描述。放射科医生必须熟悉受者免疫状态与这些疾病发病时间之间的关系，以及与各种并发症相关的神经影像学表现。CNS并发症对免疫抑制儿童可能会危及生命，因此准确诊断对于及时、恰当的治疗很重要。
