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Assessing changes in microstructural integrity of white matter tracts in children with leukaemia following exposure to chemotherapy

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Abstract

Background

Intrathecal and intravenous chemotherapy, specifically methotrexate, might contribute to neural microstructural damage.

Objective

To assess, by diffusion tensor imaging, microstructural integrity of white matter in paediatric patients with acute lymphoblastic leukaemia (ALL) following intrathecal and intravenous chemotherapy.

Materials and methods

Eleven children diagnosed with de novo ALL underwent MRI scans of the brain with diffusion tensor imaging (DTI) prior to commencement of chemotherapy and at 12 months after diagnosis, using a 3-tesla (T) MRI scanner. We investigated the changes in DTI parameters in white matter tracts before and after chemotherapy using tract-based spatial statistics overlaid on the International Consortium of Brain Mapping DTI-81 atlas. All of the children underwent formal neurodevelopmental assessment at the two study time points.

Results

Whole-brain DTI analysis showed significant changes between the two time points, affecting several white matter tracts. The tracts demonstrated longitudinal changes of decreasing mean and radial diffusivity. The neurodevelopment of the children was near compatible for age at the end of ALL treatment.

Conclusion

The quantification of white matter tracts changes in children undergoing chemotherapy showed improving longitudinal values in DTI metrics (stable fractional anisotropy, decreasing mean and radial diffusivity), which are incompatible with deterioration of microstructural integrity in these children.

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Acknowledgements

This work was partially funded by University of Malaya (Grant no. P003A-13HTM).

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Authors and Affiliations

  1. Department of Biomedical Imaging, Faculty of Medicine, University of  Malaya, Jalan Universiti, 50603, Kuala Lumpur, Malaysia

    Norlisah Ramli, Chuin Hoong Lim, Li Kuo Tan & Pohchoo Seow

  2. Department of Paediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia

    Revathi Rajagopal & Hany Ariffin

  3. Department of Diagnostic Radiology, Singapore General Hospital, Singapore, Singapore

    Pohchoo Seow

Authors
  1. Norlisah Ramli
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  2. Chuin Hoong Lim
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  3. Revathi Rajagopal
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  4. Li Kuo Tan
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  5. Pohchoo Seow
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  6. Hany Ariffin
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Correspondence to Norlisah Ramli.

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Ramli, N., Lim, C.H., Rajagopal, R. et al. Assessing changes in microstructural integrity of white matter tracts in children with leukaemia following exposure to chemotherapy. Pediatr Radiol 50, 1277–1283 (2020). https://doi.org/10.1007/s00247-020-04717-x

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  • DOI: https://doi.org/10.1007/s00247-020-04717-x

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