From the Department of Radiology, University of Minnesota, Minneapolis, Minnesota.
AJNR Am J Neuroradiol. 2020 Aug;41(8):1517-1524. doi: 10.3174/ajnr.A6624. Epub 2020 Jul 2.
Pediatric acute toxic leukoencephalopathy is a clinicoradiologic entity comprising various etiologies. This study aimed to identify the MR imaging appearance of pediatric acute toxic leukoencephalopathy from various etiologies and determine whether the etiology correlates with clinical outcome.
We retrospectively reviewed the electronic records of patients with pediatric acute toxic leukoencephalopathy younger than 19 years of age who had MR imaging within <2 weeks of presentation, including DWI and FLAIR sequences. Two neuroradiologists scored the DWI and FLAIR severity and measured the percentage ADC reduction within the visibly affected regions and normal-appearing WM. The percentage ADC reduction and DWI and FLAIR severity were correlated with clinical outcome using the Spearman correlation.
Of 22 children, 3 were excluded due to a nontoxic cause or incomplete examination. Regarding the included 19 children (mean age, 13 years), the etiologies of pediatric acute toxic leukoencephalopathy were the following: methotrexate (6), bone marrow transplantation ( = 4), fludarabine (3), cytarabine (1), carboplatin (1), vincristine (), cyclosporine (1), uremia (1), and bevacizumab (1). Three subgroups were analyzed (chemotherapy, 12; immunosuppression, 5; others, 2). There was a strong correlation of FLAIR ( 0.773< .001) and DWI (0.851< .001) severity with clinical outcome, and patients treated with fludarabine had the worst outcomes. High percentage ADC reduction values were associated with adverse outcomes, and lower percentage ADC reduction values were associated with favorable outcomes (0.570= .011).
The DWI and FLAIR severity scores appear highly prognostic, whereas percentage ADC reduction is moderately prognostic for clinical outcomes in pediatric acute toxic leukoencephalopathy. Immunosuppressive pediatric acute toxic leukoencephalopathy tends toward favorable outcomes, and fludarabine tends toward worse outcomes.
儿科急性中毒性脑白质病是一种临床影像学实体，包括多种病因。本研究旨在确定各种病因儿科急性中毒性脑白质病的磁共振成像表现，并确定病因是否与临床结果相关。
我们回顾性分析了年龄小于 19 岁、发病后 2 周内有磁共振成像（包括 DWI 和 FLAIR 序列）的儿科急性中毒性脑白质病患者的电子病历。两位神经放射科医生对 DWI 和 FLAIR 严重程度进行评分，并测量在可见病变区域和正常表现白质内的 ADC 降低百分比。使用 Spearman 相关分析，将 ADC 降低百分比和 DWI 和 FLAIR 严重程度与临床结果相关联。
在 22 名儿童中，有 3 名因非毒性原因或检查不完整而被排除。在包括的 19 名儿童（平均年龄 13 岁）中，儿科急性中毒性脑白质病的病因如下：甲氨蝶呤（6）、骨髓移植（=4）、氟达拉滨（3）、阿糖胞苷（1）、卡铂（1）、长春新碱（）、环孢素（1）、尿毒症（1）和贝伐单抗（1）。分析了 3 个亚组（化疗 12 例；免疫抑制 5 例；其他 2 例）。FLAIR（ 0.773< .001）和 DWI（0.851< .001）严重程度与临床结果具有很强的相关性，并且接受氟达拉滨治疗的患者预后最差。高 ADC 降低百分比值与不良预后相关，而低 ADC 降低百分比值与良好预后相关（0.570= .011）。
DWI 和 FLAIR 严重程度评分对预后具有高度预测性，而 ADC 降低百分比对儿科急性中毒性脑白质病的临床结果具有中度预测性。免疫抑制性儿科急性中毒性脑白质病倾向于良好的结局，而氟达拉滨则倾向于更差的结局。
