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Reversible acute methotrexate leukoencephalopathy: atypical brain MR imaging features
France Ziereisen1, Bernard Dan, Nadira Azzi
1Department of Radiology, Queen Fabiola Children's University Hospital, Avenue J J Crocq 15, 1020 Brussels, Belgium. france.ziereisen@huderf.be
Pediatric Radiology
|December 22, 2005
Summary
Methotrexate (MTX) can cause unusual, reversible brain changes in children, sometimes leading to acute neurological symptoms. Recognizing these atypical signs on MRI is crucial for diagnosis and treatment.
Area of Science:
- Pediatric Oncology
- Neuroimaging
- Toxicology
Background:
- Methotrexate (MTX) is known to induce acute, reversible leukoencephalopathy.
- Atypical presentations of MTX neurotoxicity are less understood.
Purpose of the Study:
- To determine the incidence of atypical MTX neurotoxicity in pediatric patients.
- To characterize the magnetic resonance (MR) imaging findings of this condition.
Main Methods:
- Retrospective review of clinical data and brain MRIs in 90 children treated with MTX.
- Patients received MTX for acute lymphoblastic leukemia or non-Hodgkin lymphoma.
- Brain imaging was assessed post-treatment, post-relapse, or upon neurological symptom onset.
Main Results:
- 16.7% of patients showed MTX neurotoxicity on MRI; 10% were asymptomatic with typical findings.
- 6.7% of patients exhibited acute leukoencephalopathy with atypical MR findings.
- Symptomatic patients showed T2 hyperintensities in cortical, subcortical, and cerebellar regions, differing from typical periventricular findings.
Conclusions:
- MTX can cause both typical, often asymptomatic, and unusual, severe but reversible leukoencephalopathy.
- Atypical MTX-induced leukoencephalopathy requires recognition in the differential diagnosis of acute neurological issues in pediatric patients.
- MR imaging plays a key role in identifying and characterizing MTX neurotoxicity.