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Quantitative assessment of cerebral atrophy during and after treatment in children with acute lymphoblastic leukemia
P Prassopoulos1, D Cavouras, S Golfinopoulos
1Department of Radiology, University Hospital, Medical School of Crete, Iraklion, Greece.
Insights
Brain atrophy is common in children treated for acute lymphoblastic leukemia (ALL), particularly during intrathecal chemotherapy. This condition, a key CT finding, persists even after treatment completion, affecting young children most severely.
Area of Science:
- Pediatric Oncology
- Neurology
- Radiology
Background:
- Acute lymphoblastic leukemia (ALL) treatment involves central nervous system (CNS) prophylaxis.
- Potential neurotoxic effects of ALL therapies require careful evaluation.
Purpose of the Study:
- To quantitatively assess brain atrophy in children undergoing ALL treatment.
- To determine the incidence and timing of brain atrophy during and after CNS prophylaxis.
Main Methods:
- Brain computed tomography (CT) scans of 196 children treated for ALL were analyzed.
- Subarachnoid compartment widths were measured and compared to normative data.
- CT examinations were performed during and after therapy completion.
Main Results:
- Diffuse brain atrophy was detected in 74% of scans during treatment and 65% after treatment.
- The highest incidence of atrophy (78%) occurred during intrathecal chemotherapy.
- All children under two years old showed signs of brain atrophy.
Conclusions:
- Brain atrophy is a primary CT finding in most children treated for ALL.
- Intrathecal chemotherapy is the main cause of treatment-induced brain atrophy.
- Brain atrophy can be a long-term consequence of ALL therapy.
Rationale And Objectives:
The authors evaluate quantitatively brain atrophy induced by central nervous system prophylaxis in children treated for acute lymphoblastic leukemia during and after therapy completion.
Methods:
Measurements of the width of the subarachnoid compartments were performed in 243 brain computed tomography (CT) examinations of 196 children examined during (125) and/or after (71) treatment for acute lymphoblastic leukemia without central nervous system involvement. Data were compared with normative data. RESULTS. Diffuse brain atrophy was observed in 74% and 65% of the CT examinations performed during and after cessation of treatment, respectively. The highest incidence of brain atrophy (78%) occurred during the administration of intrathecal chemotherapy. All children younger than 2 years of age exhibited brain atrophy.
Conclusions:
Brain atrophy is the principal CT finding in the majority of children treated for acute lymphoblastic leukemia and it can be attributed mainly to intrathecal chemotherapy. This finding can be observed long after therapy completion.