Quantitative morphologic evaluation of magnetic resonance imaging during and after treatment of childhood leukemia

Reddick, Wilburn E.; Laningham, Fred H.; Glass, John O.; Pui, Ching‐Hon

doi:10.1007/s00234-007-0262-9

Cited by 23 publications

(15 citation statements)

References 93 publications

(139 reference statements)

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“…The greater susceptibility of visual-auditory learning to disruption may help explain findings of greater risk for reading deficits among children with localized ependymoma after CRT. The increased vulnerability of younger children to late effects has been suggested in the literature, with one explanation being that younger children experience greater loss of white matter volume following irradiation compared to older children 37-40. It has also been suggested that visual memory may be disproportionately affected following white matter injury early in life, particularly as the right hemisphere may contain greater volume of white matter 41-44.…”

Section: Discussionmentioning

confidence: 99%

Investigating Verbal and Visual Auditory Learning After Conformal Radiation Therapy for Childhood Ependymoma

Pinto¹,

Conklin²,

Li³

et al. 2010

International Journal of Radiation Oncology*Biology*Physics

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Purpose The primary objective of this study was to determine if children with localized ependymoma experience a decline in verbal or visual-auditory learning after conformal radiation therapy (CRT). The secondary objective was to investigate the impact of age and select clinical factors on learning before and after treatment. Methods and Materials Learning in a sample of 71 patients with localized ependymoma was assessed with the California Verbal Learning Test (CVLT-C) and the Visual-Auditory Learning Test (VAL). Learning measures were administered before CRT, at six months and then yearly for a total of five years. Results There was no significant decline on measures of verbal or visual-auditory learning after CRT; however, younger age, more surgeries and CSF shunting did predict lower scores at baseline. There were significant longitudinal effects (improved learning scores after treatment) among older children on the CVLT-C and children that did not receive pre-CRT chemotherapy on the VAL. Conclusion There was no evidence of global decline in learning after CRT in children with localized ependymoma. Several important implications from the findings include: 1) identification of and differentiation among variables with transient versus long-term effects on learning; 2) demonstration that children treated with chemotherapy prior to CRT had greater risk of adverse visual-auditory learning performance, and; 3) establishment of baseline and serial assessment as critical in ascertaining necessary sensitivity and specificity for the detection of modest effects.

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Section: Discussionmentioning

confidence: 99%

Investigating Verbal and Visual Auditory Learning After Conformal Radiation Therapy for Childhood Ependymoma

Pinto¹,

Conklin²,

Li³

et al. 2010

International Journal of Radiation Oncology*Biology*Physics

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“…A recent review by Reddick et al (6) included a VBA analysis of patients during therapy for ALL stratified by age at diagnosis but did not control for treatment arm (intensity of therapy) which is highly correlated with age at diagnosis. In the current longitudinal study, all 197 subjects are used in the VBA and treatment arm is included as a covariate thus increasing the power of the study and resulting in increased statistical significance as demonstrated by the p-values achieved.…”

Section: Discussionmentioning

confidence: 99%

“…These studies demonstrated that increasing intensity of therapy, corresponding to more courses and higher doses of IV-MTX, was associated with an increased prevalence, intensity and extent of LE. Most of the LE was transient but the impact of these changes on the developing brain are unknown (6). …”

Section: Introductionmentioning

confidence: 99%

Voxel-Based Analysis of T2 Hyperintensities in White Matter during Treatment of Childhood Leukemia

Reddick¹,

Glass²,

Johnson³

et al. 2009

AJNR Am J Neuroradiol

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Background and Purpose White matter (WM) hyperintensities on T2-weighted MRI are the most common imaging manifestation of neurotoxic effects of therapy for central nervous system prophylaxis in childhood acute lymphoblastic leukemia (ALL). This project uses voxel-based analyses of T2-weighted imaging of patients during treatment to identify which WM regions are preferentially damaged. Material and Methods Two sets of conventional T2-weighted axial images were acquired on a 1.5T MRI from 197 consecutive patients (85 female / 112 male; aged 1.0-18.9 years) enrolled on an institutional ALL treatment protocol. Images were acquired after completion of induction therapy and after the final of the four courses of intravenous high-dose methotrexate in consolidation therapy (3.9±0.8 months apart). Voxel-wise statistical testing of the incremental change between normalized longitudinal T2 images was performed with radiologist reading (normal or abnormal) and treatment risk-arm as covariates. Results Two highly significant bilateral clusters of T2 signal intensity change were identified in both one-group and two-group analyses. The regions were symmetrical in size, shape, and average signal intensity. Increased T2-weighted signal intensity from these regions both within and between examinations were nonlinear functions of age at examination and the difference between the examinations was greater for older subjects which received more intense therapy. Conclusion These analyses identified specific WM tracts involving predominantly the anterior, superior, and posterior corona radiata and superior longitudinal fasciculus, which were at increased risk of developing T2-weighted hyperintensities during therapy for childhood ALL. These vulnerable regions may be the etiology of subsequent cognitive difficulties consistently observed in survivors.

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“…Prior reports have noted that in MTX-induced leukoencephalopathy diffusion, restriction appears simultaneously with symptom onset but before any white matter changes on e20 | www.jpho-online.com T2-weighted images. 10,11 However, isolated T2 hyperintensity is a finding in early-delayed radiation toxicity. 12 Ring-enhancing lesions are common MRI findings in CNS infection but are not seen in MTX-induced leukoencephalopathy.…”

Section: Discussionmentioning

confidence: 99%

Correlating Pathology With the Clinical Symptoms of Methotrexate-induced Leukoencephalopathy in a Child With Relapsed T-cell Acute Lymphoblastic Leukemia

Summers

Abramowsky²,

Cooper³

2014

Journal of Pediatric Hematology/Oncology

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Intrathecal and systemic methotrexate (MTX), as well as cranial radiation, are effective modalities to prevent central nervous system relapse in childhood acute lymphoblastic leukemia. Leukoencephalopathy is a well-described adverse effect of MTX therapy and is associated with a wide range of neurological sequelae. Most recent studies of MTX-induced leukoencephalopathy have focused exclusively on imaging findings, particularly magnetic resonance imaging. Here we report a case of severe MTX-induced leukoencephalopathy with unique magnetic resonance imaging findings and pathologic correlation from a brain biopsy taken during a period of active neurological symptomatology.

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Quantitative morphologic evaluation of magnetic resonance imaging during and after treatment of childhood leukemia

Cited by 23 publications

References 93 publications

Investigating Verbal and Visual Auditory Learning After Conformal Radiation Therapy for Childhood Ependymoma

Investigating Verbal and Visual Auditory Learning After Conformal Radiation Therapy for Childhood Ependymoma

Voxel-Based Analysis of T2 Hyperintensities in White Matter during Treatment of Childhood Leukemia

Correlating Pathology With the Clinical Symptoms of Methotrexate-induced Leukoencephalopathy in a Child With Relapsed T-cell Acute Lymphoblastic Leukemia

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