A Review of the Role of Neuroimaging in Neurotoxicity Monitoring in Children with Acute Lymphoblastic Leukemia

Neurotoxicity is one of the complications of treatment of acute lymphoblastic leukemia (ALL) with chemotherapeutic agents. Detecting any adverse changes early and effectively is important, as neurotoxicity may be reversible at certain stages. Imaging studies, such as computed tomography (CT) or magnetic resonance imaging (MRI), can be helpful in visualizing neurotoxicity. Neurotoxicity usually occurs during the first 2 months of treatment, roughly the induction phase, and includes leukoencephalopathy, encephalopathy, and posterior reversible encephalopathy syndrome. Changes mainly take the form of reduced restrictive diffusion and periventricular hyperintensity in the subcortical white matter because of cytotoxic swelling caused by ALL treatment. Some previous studies have not considered simultaneous CT and MRI, making it difficult to assess their simultaneous utility. Imaging studies are not usually included in ALL treatment protocols. However, it would be worthwhile to introduce them into clinical practice to prevent complications after chemotherapy in children with ALL, to confirm or rule out neurotoxic complications of the central nervous system more quickly. Furthermore, due to the limited number of studies, it would be advisable to develop predictive models using CT and MRI images to predict the risk of neurological complications, allowing for early prevention in at-risk patients. Considering the above, the present study aimed to evaluate the utility of MRI and CT for identifying lesions associated with neurotoxicity caused by vincristine, methotrexate, and asparaginase in pediatric patients with ALL.