PT  - JOURNAL ARTICLE
AU  - Bartynski, Walter S.
AU  - Zeigler, Zella
AU  - Spearman, Michael P.
AU  - Lin, Luke
AU  - Shadduck, Richard K.
AU  - Lister, John
TI  - Etiology of Cortical and White Matter Lesions in Cyclosporin-A and FK-506 Neurotoxicity
DP  - 2001 Nov 01
TA  - American Journal of Neuroradiology
PG  - 1901--1914
VI  - 22
IP  - 10
4099  - http://www.ajnr.org/content/22/10/1901.short
4100  - http://www.ajnr.org/content/22/10/1901.full
SO  - Am. J. Neuroradiol.2001 Nov 01; 22
AB  - BACKGROUND AND PURPOSE: The etiology of the neurotoxicity associated with cyclosporin-A (CsA) and FK-506 treatment is not fully understood. At our institution, we noticed a distinct, abrupt change in the imaging characteristics of CsA and FK-506 neurotoxicity, which consisted of a shift in lesion morphology from a white matter abnormality to a mixed cortical and white matter pattern. The purpose of this study was to assess clinical parameters that might explain this change.METHODS: Twenty-two patients had a neurotoxic reaction and brain imaging changes while receiving CsA or FK-506. Nineteen patients received allogeneic bone marrow transplants, and three had aplastic marrow disorders. Fifty-one imaging studies (CT or MR imaging) were obtained, and lesion characteristics, locations, and time courses were evaluated along with relevant clinical data.RESULTS: Nine patients who had been conditioned for transplantation with cyclophosphamide and chemotherapy (busulfan or thiotepa) had a mixed pattern of cortical and white matter involvement (57 lesions). Isolated white matter involvement (62 lesions) developed in three nontransplant patients and 10 transplant patients conditioned with cyclophosphamide and total-body irradiation. All lesions occurred at typical brain watershed zones. Lesion enhancement was noted in two patients conditioned with chemotherapy. Initial images demonstrated characteristic lesions in 15 patients (68%). Initial images were normal in four patients (18%) and nonspecific in three patients (14%).CONCLUSION: Lesion location in CsA and FK-506 neurotoxicity may depend on the presence or type of conditioning used before bone marrow transplantation. Nontransplant patients or those conditioned with total-body irradiation develop white matter lesions, whereas those conditioned with chemotherapy develop mixed cortical and white matter lesions.