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AJNR - American Journal of Neuroradiology

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A Quantitative MR Imaging Assessment of Leukoencephalopathy in Children Treated for Acute Lymphoblastic Leukemia without Irradiation

Wilburn E. Reddick^a,f, John O. Glass^a, Kathleen J. Helton^a,d, James W. Langston^d, Chin-Shang Li^b and Ching-Hon Pui^c,e

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

View larger version (41K): [in a new window]   FIG 1. A single section from a typical examination after completion of IV-MTX demonstrating LE appearance on FLAIR image, segmented tissue map, quantitative T1 and quantitative T2 maps (left to right). LE is most evident in the frontal white matter.

View larger version (22K): [in a new window]   FIG 2. Predicted probability of developing LE according to a general linear model previously reported for patients on the standard- or high-risk arm (light gray bars) and patients on the low-risk arm (black bars) of the treatment protocol. Quantitative MR measures were evaluated post 1, 4, and 7 courses of IV-MTX and at end of therapy (EOT).

View larger version (22K): [in a new window]   FIG 3. Proportion of white matter affected (extent of LE) for patients on the standard- or high-risk arm (light gray bars) and patients on the low-risk arm (black bars) of the treatment protocol. Statistical results from a nonparameteric one-sided Wilcoxon-Mann-Whitney test are shown for both within and between groups at each of the 4 time points. Quantitative MR measures were evaluated post 1, 4, and 7 courses of IVMTX and at end of therapy (EOT).

View larger version (19K): [in a new window]   FIG 4. Increase in T1 relaxation rate of LE over NAWM (intensity of LE) for patients on the standard- or high-risk arm (light gray bars) and patients on the low-risk arm (black bars) of the treatment protocol. Statistical results from a nonparameteric one-sided Wilcoxon-Mann-Whitney test are shown for both within and between groups at each of the 4 time points. Quantitative MR measures were evaluated post 1, 4, and 7 courses of IV-MTX and at end of therapy (EOT).

View larger version (20K): [in a new window]   FIG 5. Increase in T2 relaxation rate of LE over NAWM (intensity of LE) for patients on the standard- or high-risk arm (light gray bars) and patients on the low-risk arm (black bars) of the treatment protocol. Statistical results from a nonparameteric one-sided Wilcoxon-Mann-Whitney test are shown for both within and between groups at each of the 4 time points. Quantitative MR measures were evaluated post 1, 4, and 7 courses of IV-MTX and end of therapy (EOT).

View larger version (15K): [in a new window]   FIG 6. Scatter plot of increase in T1 and T2 relaxation rates for patients on both arms of the treatment protocol. The solid line is the result of a simple linear robust regression analysis. Increases in T1 and T2 relaxation relative to NAWM were highly correlated.