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Leukoencephalopathy following high-dose intravenous methotrexate chemotherapy: quantitative assessment of white
Insights
Leukoencephalopathy can occur in children treated for acute lymphatic leukemia or bone tumors with certain chemotherapy regimens. A new computerized CT scan analysis method offers a more reliable way to detect white matter changes than visual assessment.
Area of Science:
- Neuro-oncology
- Pediatric oncology
- Radiology
Background:
- Leukoencephalopathy is a known complication in children treated for acute lymphatic leukemia (ALL) using cranial radiation therapy and methotrexate.
- High-dose methotrexate (MTX) with citrovorum factor (CF) for bone tumors can also induce leukoencephalopathy, even without cranial irradiation.
Observation:
- Computed tomography (CT) scans may show decreased white matter attenuation in affected patients.
- Visual assessment of white matter hypodensity on CT scans can be unreliable.
Findings:
- A computerized method was developed to analyze white matter hypodensity by calculating the mean attenuation coefficient from CT slices.
- Serial comparisons of this mean attenuation coefficient provide a more reliable assessment of leukoencephalopathy than visual appraisal.
Implications:
- This quantitative CT analysis method can improve the detection and monitoring of methotrexate-induced leukoencephalopathy in pediatric cancer patients.
- Accurate identification of leukoencephalopathy is crucial for treatment adjustments and managing long-term neurological sequelae.
Abstract:
A clinical or subclinical leukoencephalopathy occurs in some children after treatment of acute lymphatic leukemia with prophylactic cranial radiation therapy and parenteral or intrathecal methotrexate. We have observed a similar clinical leukoencephalopathy in patients with bone tumors treated with intravenous high-dose methotrexate and citrovorum factor without cranial irradiation. CT scans of such patients may indicate decreased white matter attenuation, but visual appraisal of this phenomenon is occasionally misleading. A computerized method for analyzing white matter hypodensity by determining the mean attenuation coefficient for one or several contiguous CT slices has therefore been developed. Serial comparisons of this mean attenuation coefficient appear to be more reliable than simple visual appraisal.