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首页> 外文期刊>Oncology letters >Magnetic resonance imaging of the brain in survivors of childhood acute lymphoblastic leukemia
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Magnetic resonance imaging of the brain in survivors of childhood acute lymphoblastic leukemia

机译：儿童急性淋巴细胞白血病幸存者的大脑磁共振成像

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摘要

The issue of delayed neurological damage as a result of treatment is becoming increasingly important now that an increased number of children survive treatment for acute lymphoblastic leukemia (ALL). Following modification of the treatment protocols, severe symptomatic late effects are rare, and most adverse effects are detected by sensitive imaging methods such as magnetic resonance imaging (MRI) or by neuropsychological testing. In this study we aimed to determine the prevalence and characteristics of late central nervous system (CNS) damage by MRI and clinical examination in children treated for ALL. A cross-sectional study was carried out at the pediatric oncology unit of Zagazig University, Egypt, and included 25 patients who were consecutively enrolled and treated according to the modified Children's Cancer Group (CCG) 1991 protocol for standard risk ALL and the modified CCG 1961 protocol for high-risk ALL and who had survived more than 5 years from the diagnosis. All relevant data were collected from patients' medical records; particularly the data concerning the initial clinical presentation and initial brain imaging. All patients were subjected to thorough history and full physical examination with special emphasis on the neurological system. MRI of the brain was performed for all patients. The mean age of patients was 6.9 +/- 3.04 years at diagnosis and was 12.9 +/- 3.2 years at the time of study. The patients comprised 14 boys and 11 girls. Abnormal MRI findings were detected in six patients (24%). They were in the form of leukoencephalopathy in two patients (8%), brain atrophy in two patients (8%), old infarct in one patient (4%) and old hemorrhage in one patient (4%). The number of abnormal MRI findings was significantly higher in high-risk patients, patients who had CNS manifestations at diagnosis and patients who had received cranial irradiation. We concluded that cranial irradiation is associated with higher incidence of MRI changes in children treated for ALL. Limitation of cranial irradiation to selected patients contributed to a lower incidence of neurological complications in our study. MRI is a sensitive radiological tool to detect structural changes in children treated for ALL, even in asymptomatic cases.
机译：由于越来越多的儿童能够接受急性淋巴细胞白血病（ALL）的治疗，因此治疗导致的神经系统损害延迟的问题变得越来越重要。修改治疗方案后，很少出现严重的症状迟发症状，并且大多数不良反应都是通过敏感的成像方法（如磁共振成像（MRI）或神经心理学测试）检测到的。在这项研究中，我们旨在通过MRI和临床检查确定接受ALL治疗的儿童的晚期中枢神经系统（CNS）损伤的发生率和特征。埃及Zagazig大学的儿科肿瘤科进行了一项横断面研究，纳入了25名患者，这些患者已根据经修改的1991年儿童癌症小组（CCG）的标准风险ALL和经修改的CCG 1961方案进行了入组和治疗诊断后存活超过5年的高危ALL的治疗方案。所有相关数据均来自患者的病历;特别是有关初始临床表现和初始脑成像的数据。所有患者均接受了彻底的病史和全面的身体检查，尤其是神经系统。所有患者均行脑部MRI检查。诊断时患者的平均年龄为6.9 +/- 3.04岁，研究时为12.9 +/- 3.2岁。患者包括14名男孩和11名女孩。在六名患者（24％）中发现了MRI异常。他们的形式有2例（8％）的白质脑病，2例（8％）的脑萎缩，1例（4％）的老梗塞和1例（4％）的老出血。在高危患者，确诊为CNS表现的患者以及接受颅骨放射治疗的患者中，MRI异常发现的数量明显更高。我们得出的结论是，接受ALL治疗的儿童颅骨照射与MRI改变发生率更高相关。在本研究中，仅对选定的患者进行颅骨照射限制了神经系统并发症的发生率。 MRI是一种敏感的放射学工具，即使在无症状的情况下，也可以检测接受ALL治疗的儿童的结构变化。

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