Cranial MRI in Childhood Acute Leukemia during Treatment and Follow-Up Including the Impact of Intrathecal MTX—A Single-Center Study and Review of the Literature

SIMPLE SUMMARY: Acute leukemias in children have an excellent outcome. Therefore, reasons for long-term sequelae need to be discovered to avoid them. Our retrospective analysis in addition to a literature review focuses on neurotoxicity by investigating cerebral morphologic changes diagnosed in cranial MRIs in children with acute leukemias. Such changes occur in more than 50% of children. They were detected especially in patients below 6 years of age, in ALL and in patients receiving more than 12 intrathecal MTX applications. The ventricular width, as one of the cerebral abnormalities, has the potential to normalize again. It is important to prospectively investigate and correlate these changes with the neurocognitive outcome in children with acute leukemias to evaluate the impact of intrathecal MTX in this context. ABSTRACT: Due to high survival rates, long-term sequelae, especially neurotoxicity, need to be considered in childhood acute leukemias. In this retrospective analysis of morphologic changes of the brain in children treated for acute leukemias, we included 94 patients (77 ALL, 17 AML; 51 male, 43 female; median age: 5 years) from a single center. We analyzed 170 cranial MRI scans (T2, FLAIR axial) for morphologic alterations of the brain and variations of the ventricular width (GDAH). In addition, the corresponding literature was reviewed. More than 50% of all patients showed cerebral pathomorphologies (CP). They were seen more often in children with ALL (55.8%), [Formula: see text] 6 years of age (60.8%), in relapse (58.8%) or after CNS irradiation (75.0%) and included white matter changes, brain atrophy, sinus vein thrombosis and ischemic events. GDAH significantly enlarged mainly in children up to 6 years, with relapse, high-risk leukemias or ALL patients. However, GDAH can normalize again. The number of intrathecal Methotrexate applications (≤12 vs. >12) showed no correlation to morphologic alterations besides a significant increase in GDAH (−0.3 vs. 0.9 mm) between the first and last follow-up MRI in ALL patients receiving >12 ith. MTX applications. The role of ith. MTX on CP needs to be further investigated and correlated to the neurocognitive outcome of children with acute leukemias.