White matter and cerebral metabolite changes in children undergoing treatment for acute lymphoblastic leukemia:: Longitudinal study with MR imaging and 1H MR spectroscopy
White matter and cerebral metabolite changes in children undergoing treatment for acute lymphoblastic leukemia:: Longitudinal study with MR imaging and 1H MR spectroscopy
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DOI：
10.1148/radiol.2293021550
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发表时间：
2003-12-01
期刊：
影响因子：
19.7
通讯作者：
Metreweli, C
中科院分区：
文献类型：
--
作者：
Chu, WCW;Chik, KW;Metreweli, C
目的：探讨急性淋巴细胞性白血病患儿治疗前后脑白质发育及代谢产物的变化。材料与方法：对23例急性淋巴细胞性白血病患儿(男10例，平均年龄6.3岁；女13例，平均年龄6.6岁)分别于发病后0、8、20周、1、2、3年进行磁共振成像及波谱检查。脑白质改变的诊断依据是T2加权MR图像上的高信号异常。对21例接受大剂量甲氨蝶呤静脉注射的儿童右额顶区的单体素氢1磁共振波谱结果进行了分析，以了解脑代谢的变化。结果：在20周时，磁共振波谱显示服用高剂量甲氨蝶呤的儿童平均N-乙酰天冬氨酸/胆碱比值显著降低(P<；0.05)，而平均胆碱/肌酸比值显著升高(P<；0.05)。这种N-乙酰天冬氨酸与胆碱比值的下降随后逆转并增加，可能是因为正常的年龄相关的大脑成熟。21名儿童中有17名(81%)在磁共振波谱上显示代谢物变化，而在20周时，22名儿童中有5名(23%)在磁共振成像上显示脑白质变化。又有一个孩子在32周时出现了脑白质变化。相关改变随着时间的推移逐渐消失或减少。结论：磁共振波谱显示大剂量甲氨蝶呤治疗后脑内代谢产物的改变，在磁共振成像中没有脑白质结构异常。因此，磁共振波谱可能是监测大剂量甲氨蝶呤对大脑影响的更灵敏的方法。(C)RSNA，2003年。
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.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-close 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. (C) RSNA, 2003.