Magnetic resonance imaging of the brain in survivors of childhood acute lymphoblastic leukemia
Magnetic resonance imaging of the brain in survivors of childhood acute lymphoblastic leukemia
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DOI：
10.3892/ol.2012.1072
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发表时间：
2013-02-01
期刊：
影响因子：
2.9
通讯作者：
Lamey, Mohamed El-Sayed
中科院分区：
文献类型：
--
作者：
Badr, Mohamed Ahmed;Hassan, Tamer Hasan;Lamey, Mohamed El-Sayed
随着急性淋巴细胞白血病（ALL）患儿存活率的增加，治疗导致的延迟性神经损伤问题变得越来越重要。在修改治疗方案后，严重的症状性晚期效应是罕见的，大多数不良反应是通过敏感的成像方法，如磁共振成像（MRI）或神经心理测试检测到的。在这项研究中，我们旨在通过MRI和临床检查确定ALL患儿晚期中枢神经系统（CNS）损伤的患病率和特征。在埃及Zagazig大学儿科肿瘤科进行了一项横断面研究，纳入了25例患者，这些患者连续入组并根据修订后的儿童癌症组（CCG） 1991年标准风险ALL方案和修订后的CCG 1961年高风险ALL方案进行治疗，并且自诊断后存活超过5年。所有相关数据均从患者病历中收集；特别是关于初始临床表现和初始脑成像的数据。所有患者都进行了详细的病史和全面的体格检查，特别强调神经系统。所有患者均行脑MRI检查。患者诊断时的平均年龄为6.9 +/- 3.04岁，研究时的平均年龄为12.9 +/- 3.2岁。患者包括14名男孩和11名女孩。6例（24%）患者MRI表现异常。表现为脑白质病变2例（8%），脑萎缩2例（8%），陈旧性梗死1例（4%），陈旧性出血1例（4%）。高危患者、诊断时有中枢神经系统表现的患者和接受过颅脑照射的患者MRI异常发生率明显较高。我们的结论是，在ALL治疗的儿童中，颅脑照射与较高的MRI改变发生率相关。在我们的研究中，限制对特定患者的颅照射有助于降低神经系统并发症的发生率。MRI是一种敏感的放射学工具，可以检测ALL治疗儿童的结构变化，即使在无症状的病例中也是如此。
The issue of delayed neurological damage as a result of treatment is becoming increasingly important now that an increased number of children survive treatment for acute lymphoblastic leukemia (ALL). Following modification of the treatment protocols, severe symptomatic late effects are rare, and most adverse effects are detected by sensitive imaging methods such as magnetic resonance imaging (MRI) or by neuropsychological testing. In this study we aimed to determine the prevalence and characteristics of late central nervous system (CNS) damage by MRI and clinical examination in children treated for ALL. A cross-sectional study was carried out at the pediatric oncology unit of Zagazig University, Egypt, and included 25 patients who were consecutively enrolled and treated according to the modified Children's Cancer Group (CCG) 1991 protocol for standard risk ALL and the modified CCG 1961 protocol for high-risk ALL and who had survived more than 5 years from the diagnosis. All relevant data were collected from patients' medical records; particularly the data concerning the initial clinical presentation and initial brain imaging. All patients were subjected to thorough history and full physical examination with special emphasis on the neurological system. MRI of the brain was performed for all patients. The mean age of patients was 6.9 +/- 3.04 years at diagnosis and was 12.9 +/- 3.2 years at the time of study. The patients comprised 14 boys and 11 girls. Abnormal MRI findings were detected in six patients (24%). They were in the form of leukoencephalopathy in two patients (8%), brain atrophy in two patients (8%), old infarct in one patient (4%) and old hemorrhage in one patient (4%). The number of abnormal MRI findings was significantly higher in high-risk patients, patients who had CNS manifestations at diagnosis and patients who had received cranial irradiation. We concluded that cranial irradiation is associated with higher incidence of MRI changes in children treated for ALL. Limitation of cranial irradiation to selected patients contributed to a lower incidence of neurological complications in our study. MRI is a sensitive radiological tool to detect structural changes in children treated for ALL, even in asymptomatic cases.