American Journal of Neuroradiology 26:1686-1689, August 2005
© 2005 American Society of Neuroradiology
PEDIATRICS
Diffusion-Weighted MR Imaging of Early Methotrexate-Related Neurotoxicity in Children
a Division of Neuroradiology, Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA
b Division of Oncology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA
Address correspondence to Michael J. Fisher, MD, Division of Oncology, Children’s Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104
BACKGROUND AND PURPOSE: Methotrexate is a major cause of treatment-related acute neurotoxicity in children with hematologic malignancies. The purpose of this study was to investigate whether diffusion-weighted MR imaging (DWI) detects acute methotrexate white matter neurotoxicity in this patient population.
METHODS: Six children—three female and three male—with hematologic malignancies were studied at time of onset of neurologic dysfunction during the delayed intensification or consolidation phase of therapy, when intensive intrathecal methotrexate is given. MR imaging including DWI was performed on 1.5 T MR scanners.
RESULTS: DWI demonstrated abnormal restriction of motion of water in the centrum semiovale in all six patients. This finding correlated to the acute onset of hemiparesis or aphasia. Fluid-attenuated inversion recovery imaging was not positive at this time, but it was positive in all five patients in whom follow-up imaging was performed.
CONCLUSION: Early detection of methotrexate white matter injury by DWI has the potential to alert the oncologist to this event and provide a technique by which treatment of neurotoxicity can be monitored.
This article has been cited by other articles:
 |
|
 |
|
  S. R. Kesler, F. C. Bennett, M. L. Mahaffey, and D. Spiegel Regional Brain Activation during Verbal Declarative Memory in Metastatic Breast Cancer Clin. Cancer Res., November 1, 2009; 15(21): 6665 - 6673. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Dicuonzo, A. Salvati, M. Palma, V. Lefons, G. Lasalandra, F. De Leonardis, and N. Santoro Posterior Reversible Encephalopathy Syndrome Associated With Methotrexate Neurotoxicity: Conventional Magnetic Resonance and Diffusion-Weighted Imaging Findings J Child Neurol, August 1, 2009; 24(8): 1013 - 1018. [Abstract] [PDF]
|
|
|
|
 |
|
 A. M. McKinney, S. A. Kieffer, R. T. Paylor, K. S. SantaCruz, A. Kendi, and L. Lucato Acute Toxic Leukoencephalopathy: Potential for Reversibility Clinically and on MRI With Diffusion-Weighted and FLAIR Imaging Am. J. Roentgenol., July 1, 2009; 193(1): 192 - 206. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J M Baehring and R K Fulbright Delayed leukoencephalopathy with stroke-like presentation in chemotherapy recipients J. Neurol. Neurosurg. Psychiatry, May 1, 2008; 79(5): 535 - 539. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. F. Eichler, T. T. Batchelor, and J. W. Henson Diffusion and perfusion imaging in subacute neurotoxicity following high-dose intravenous methotrexate Neuro Oncology, July 1, 2007; 9(3): 373 - 377. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Soussain, L. L. Muldoon, C. Varallyay, K. Jahnke, L. DePaula, and E. A. Neuwelt Characterization and Magnetic Resonance Imaging of a Rat Model of Human B-Cell Central Nervous System Lymphoma Clin. Cancer Res., April 15, 2007; 13(8): 2504 - 2511. [Abstract] [Full Text] [PDF]
|
|