Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Jalan Universiti, 50603, Kuala Lumpur, Malaysia.
Department of Paediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Pediatr Radiol. 2020 Aug;50(9):1277-1283. doi: 10.1007/s00247-020-04717-x. Epub 2020 Jun 26.
Intrathecal and intravenous chemotherapy, specifically methotrexate, might contribute to neural microstructural damage.
To assess, by diffusion tensor imaging, microstructural integrity of white matter in paediatric patients with acute lymphoblastic leukaemia (ALL) following intrathecal and intravenous chemotherapy.
Eleven children diagnosed with de novo ALL underwent MRI scans of the brain with diffusion tensor imaging (DTI) prior to commencement of chemotherapy and at 12 months after diagnosis, using a 3-tesla (T) MRI scanner. We investigated the changes in DTI parameters in white matter tracts before and after chemotherapy using tract-based spatial statistics overlaid on the International Consortium of Brain Mapping DTI-81 atlas. All of the children underwent formal neurodevelopmental assessment at the two study time points.
Whole-brain DTI analysis showed significant changes between the two time points, affecting several white matter tracts. The tracts demonstrated longitudinal changes of decreasing mean and radial diffusivity. The neurodevelopment of the children was near compatible for age at the end of ALL treatment.
The quantification of white matter tracts changes in children undergoing chemotherapy showed improving longitudinal values in DTI metrics (stable fractional anisotropy, decreasing mean and radial diffusivity), which are incompatible with deterioration of microstructural integrity in these children.
鞘内和静脉化疗，特别是甲氨蝶呤，可能导致神经微观结构损伤。
通过弥散张量成像评估接受鞘内和静脉化疗的小儿急性淋巴细胞白血病（ALL）患者的白质微观结构完整性。
11 名初诊 ALL 患儿在开始化疗前和诊断后 12 个月，使用 3T MRI 扫描仪进行脑部 MRI 扫描和弥散张量成像（DTI）。我们使用基于束的空间统计学，对国际脑图谱弥散张量成像-81 图谱进行叠加，研究化疗前后白质束 DTI 参数的变化。所有患儿在两个研究时间点均进行了正式的神经发育评估。
全脑 DTI 分析显示，在两个时间点之间存在显著变化，影响了几个白质束。这些束的纵向变化表现为平均和径向弥散度降低。在 ALL 治疗结束时，患儿的神经发育与年龄接近。
接受化疗的患儿白质束变化的定量显示，DTI 指标的纵向值改善（各向异性分数稳定，平均弥散度和径向弥散度降低），这与这些患儿的微观结构完整性恶化不一致。
