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Updated: Aug 16, 2026
Diffusion Tensor Magnetic Resonance Imaging in the Analysis of Neurodegenerative Diseases
Published on: July 28, 2013
Diffusion-weighted MR imaging of early methotrexate-related neurotoxicity in children
Michael J Fisher1, Zarir P Khademian, Erin M Simon
1Division of Neuroradiology, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
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.
Insights
Diffusion-weighted MR imaging (DWI) can detect early signs of methotrexate-induced white matter injury in children with hematologic malignancies. This technique aids oncologists in identifying and monitoring neurotoxicity during treatment.
Area of Science:
- Pediatric Oncology
- Neuroradiology
- Neurotoxicity
Background:
- Methotrexate (MTX) is a critical chemotherapy agent for pediatric hematologic malignancies.
- Treatment-related neurotoxicity is a significant complication of MTX therapy in children.
- Acute white matter injury is a recognized adverse effect of MTX.
Purpose of the Study:
- To evaluate the utility of diffusion-weighted magnetic resonance imaging (DWI) in detecting acute methotrexate-induced white matter neurotoxicity.
- To assess the correlation between DWI findings and clinical neurological symptoms in pediatric patients.
Main Methods:
- A cohort of six children with hematologic malignancies experiencing neurological dysfunction during MTX therapy was studied.
- Magnetic resonance imaging (MRI), including DWI, was performed using 1.5 T scanners.
- Clinical presentation and neurological deficits were recorded at the time of imaging.
Main Results:
- DWI revealed restricted water diffusion in the centrum semiovale in all six pediatric patients.
- These DWI findings correlated with the acute onset of clinical symptoms such as hemiparesis and aphasia.
- Fluid-attenuated inversion recovery (FLAIR) imaging was initially negative but became positive on follow-up in five patients.
Conclusions:
- Diffusion-weighted imaging (DWI) is a sensitive tool for the early detection of methotrexate-induced white matter injury.
- DWI findings can prompt oncologists to consider MTX neurotoxicity as a diagnosis.
- This imaging technique offers a method for monitoring the progression and response to treatment of MTX-related neurotoxicity.
