White Matter and Cerebral Metabolite Changes in Children Undergoing Treatment for Acute Lymphoblastic Leukemia: Longitudinal Study with MR Imaging and 1 H MR Spectroscopy
2003; Radiological Society of North America; Volume: 229; Issue: 3 Linguagem: Inglês
10.1148/radiol.2293021550
ISSN1527-1315
AutoresChiu‐Wing Winnie Chu, Ki-Wai Chik, Yu-Leung Chan, David K. W. Yeung, Derek Roebuck, Robert Howard, Chi Kong Li, Constantine Metreweli,
Tópico(s)Advanced NMR Techniques and Applications
ResumoPURPOSE: To assess the development of white matter and cerebral metabolite changes during and after treatment in children with acute lymphoblastic leukemia. MATERIALS AND METHODS: Twenty-three children (10 boys, mean age of 6.3 years; 13 girls, mean age of 6.6 years) with acute lymphoblastic leukemia were examined prospectively with magnetic resonance (MR) imaging and MR spectroscopy at 0, 8, and 20 weeks and 1, 2, and 3 years after diagnosis. White matter changes were diagnosed on the basis of hyperintense abnormalities on T2-weighted MR images. Single-voxel hydrogen 1 MR spectroscopy results from the right frontoparietal region of 21 children who received intravenous high-dose methotrexate were analyzed for cerebral metabolite changes. Multilevel models were used to assess the change in metabolites from baseline levels at subsequent follow-up. RESULTS: At 20 weeks, MR spectroscopy showed a significant reduction (P < .05) of mean N-acetylaspartate to choline ratio and increase in mean choline to creatine ratio (P < .05) in the children given high-dose methotrexate. This decline in N-acetylaspartate to choline ratio subsequently reversed and increased, possibly because of normal age-related brain maturation. Seventeen of 21 (81%) children showed metabolite changes at MR spectroscopy, while five of 22 (23%) showed white matter changes at MR imaging at 20 weeks. One more child developed white matter changes at 32 weeks. The associated changes resolved or reduced with time. CONCLUSION: MR spectroscopy demonstrated metabolite changes in the brain after high-dose methotrexate treatment in the absence of structural white matter abnormalities at MR imaging. MR spectroscopy might thus be a more sensitive method of monitoring the effects of high-dose methotrexate in the brain. © RSNA, 2003
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