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Computer assisted tomography in methotrexate encephalopathy.

N Peylan-Ramu, D G Poplack, C L Blei

    Journal of Computer Assisted Tomography
    |April 1, 1977
    PubMed
    Summary
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    Methotrexate (MTX) treatment for acute lymphocytic leukemia (ALL) can cause encephalopathy in children. CT scans revealed characteristic brain changes, including decreased attenuation and calcifications, in affected patients.

    Area of Science:

    • Neuro-oncology
    • Pediatric Neurology
    • Radiology

    Background:

    • Intrathecal or intraventricular methotrexate (MTX) is a standard treatment for acute lymphocytic leukemia (ALL).
    • Encephalopathy is a potential, though rare, adverse effect of MTX chemotherapy.
    • Understanding the neuroimaging manifestations of MTX-induced encephalopathy is crucial for diagnosis and management.

    Observation:

    • Five pediatric patients with ALL developed encephalopathy after receiving intrathecal or intraventricular MTX.
    • Neuroimaging was performed to evaluate the neurological symptoms.
    • One additional child without ALL also presented with MTX encephalopathy.

    Findings:

    • Computer-assisted tomography (CT) revealed significant findings in the affected children.

    Related Experiment Videos

  • Common CT findings included periventricular decreased attenuation and centrum semiovale involvement (3/5 patients).
  • Other observed abnormalities were calcifications in the deep and cortical gray matter (2/5 patients) and ventricular dilatation (4/5 patients).
  • Contrast enhancement was notably absent in the one patient who received it, as well as in the additional child with MTX encephalopathy.

    • Implications:

    • CT imaging can identify characteristic patterns of MTX-induced encephalopathy in children treated for ALL.
    • The absence of contrast enhancement suggests a non-inflammatory or non-vasogenic mechanism for these CT findings.
    • These neuroimaging findings aid in differentiating MTX toxicity from other neurological complications in pediatric ALL patients.