White Matter and Cerebral Metabolite Changes in Children Undergoing Treatment for Acute Lymphoblastic Leukemia: Longitudinal Study with MR Imaging and ¹H MR Spectroscopy¹

¹ From the Depts of Diagnostic Radiology and Organ Imaging (W.C. W.C., Y.L.C., R.G.H., C.M.), Paediatrics (K.W.C., C.K.L.), and Clinical Oncology, Medical Physics Div (D.K.W.Y.), Chinese Univ of Hong Kong, Prince of Wales Hosp, 30–32 Ngan Shing St, Shatin, Hong Kong SAR, China; and Dept of Radiology, Great Ormond Street Hospital for Children, London, England (D.J.R.). Received Dec 3, 2002; revision requested Feb 6, 2003; final revision received Apr 11; accepted May 20. Address correspondence to W.C.W.C. (e-mail: winnie@med.cuhk.edu.hk).

	ABSTRACT

 
PURPOSE: 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..........

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High-dose methotrexate is effective for CNS prophylaxis in children with acute lymphoblastic leukemia, but the treatment is known to cause white matter abnormality (leukoencephalopathy), detected as regions of hyperintensity on T2-weighted magnetic resonance (MR) images (9,10). The reported incidence of white matter abnormality shown in the early posttreatment period (11) is much higher compared with that in the later stages (12–14). Most of these changes are transient in nature, and they disappear within 12–24 months with negative follow-up imaging results (12).

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