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AJNR - American Journal of Neuroradiology

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Prevalence of Leukoencephalopathy in Children Treated for Acute Lymphoblastic Leukemia with High-Dose Methotrexate

Wilburn E. Reddick^a,f, John O. Glass^a, Kathleen J. Helton^a,d, James W. Langston^a,d, Xiaoping Xiong^b, Shengjie Wu^b and Ching-Hon Pui^c,e

^a Division of Translational Imaging Research, St Jude Children’s Research Hospital
^b Department of Biostatistics, St Jude Children’s Research Hospital
^c Department of Hematology/Oncology, St Jude Children’s Research Hospital
^d Department of Radiological Sciences, University of Tennessee Health Science Center
^e Department of Pediatrics, University of Tennessee Health Science Center
^f Departments of Electrical and Computer Engineering and Biomedical Engineering, University of Memphis, Memphis, Tennessee

View larger version (67K): [in a new window]   FIG 1. T1-, T2-, and proton density–weighted and FLAIR images (left to right) from a typical examination. LE can be seen in the white matter posterior to the ventricles.

View larger version (13K): [in a new window]   FIG 2. Cumulative risk for LE as a function of time since diagnosis. Solid line represents patients in the standard- and high-risk treatment arm; dashed line, those in the low-risk treatment arm.

View larger version (24K): [in a new window]   FIG 3. Observed prevalence of LE in patients in the standard- or high-risk arm (gray bars) and patients in the low-risk arm (black bars) of the treatment protocol.

View larger version (31K): [in a new window]   FIG 4. Predicted probability of LE according to the general linear model for patients in the standard- or high-risk arm (gray bars) and patients in the low-risk arm (black bars) of the treatment protocol.

View larger version (102K): [in a new window]   FIG 5. FLAIR images from a typical examination. Left to right, Sections after one course, four courses, and seven courses of high-dose IV MTX therapy; at the end of therapy; and at 2 years after the completion of therapy. A, Transient LE. Although the first image is normal, the second and third show LE, which resolves by the fourth and remains normal on the final image. B, Persistent LE. First image is normal, but all others, including the 2-year follow-up image, show LE.