Magnetic resonance imaging of changes in the brain of children cured of acute lymphoblastic leukemia

Abstract

This study was aimed to systematize magnetic resonance imaging (MRI) presentation of toxic leukoencephalopathy, to find the correlation between method of central nervous system (CNS) leukemia prevention and changes on MRI, to find relationship between existence leukoencephalopathy on imaging and neurocognitive deficits in pediatric patients after anti-leukemic therapy. Brain MRI data of 48 children, who underwent a therapy course according to the ALL-MB intermediate risk protocol, was evaluated. In accordance with two arms of this protocol, they received either radiation therapy, or additional intrathecal administration of chemotherapeutic agents as a prevention of CNS leukemia. Also, neurocognitive tests were performed. According to the results of the performed investigation, 10 (50%) out of 20 children, who received cranial irradiation and 18 (66.6%) out of 27 patients, who received only intrathecal therapy demonstrated abnormal brain changes (leukoencephalopathy) according to MRI data. Leukoencephalopathy was mostly presented by diffuse zones and localized predominantly in the frontal and temporal lobes. There was no correlation between method of CNS prevention and the existence of leukoencephalopathy on MRI. The analysis of our data did not show significant differences in brain damage and severity of cognitive impairment depending on the type of prevention of CNS leukemia. Moreover, in this study no statistical correlation was found between leukoencephalopathy on MRI and neurocognitive impairment according to clinical tests data. Further long-term prospective studies and examinations should be performed to assess late neurotoxic effects.

The role of magnetic resonance imaging in the diagnosis of central nervous system involvement in children with acute lymphoblastic leukemia

“…Unspecific meningeal enhancement following LP is possible; however, LP prior to MRI does not seem to affect MRI results 12 . Furthermore, therapy‐induced abnormalities of the meninges including secondary tumors, such as meningiomas, can be observed in relapsed patients, 13 which has to be considered in the differential diagnosis. Usually, however, MRI findings of these pathologies are different.…”

Cranial MRI in Childhood Acute Leukemia during Treatment and Follow-Up Including the Impact of Intrathecal MTX—A Single-Center Study and Review of the Literature

“…The main cause is treatment with potential neurotoxic drugs during the vulnerable phase of brain maturation [38][39][40]. The literature can be divided into two groups, firstly about morphologic changes of the brain in children treated for acute leukemias alone [15][16][17][18][19][20][21][22][23][24][25][26][27][28]41,42] and secondly about the association between cMRI alterations and neurocognitive sequelae [2][3][4][5][6][7][8][9][10][11][12][13]22,34,[43][44][45][46].…”

“…Besides the effectiveness of the current treatments, short-and long-term sequelae need to be taken seriously. Deterioration of neurocognitive function is one of the most relevant late effects [2][3][4][5][6][7][8][9][10][11][12][13]. To analyze the reason for declined neurocognitive abilities, imaging studies of the central nervous system (CNS) are helpful Cancers 2022, 14, 4688 2 of 16 to find correlated morphological changes.…”