Role of MRI in the evaluation of postchemotherapy brain changes in childhood leukemia: An Egyptian study

Abstract

Aim of the study: To evaluate the role of MRI in the detection of the side effects of chemotherapy on the brain in leukemic children presenting with clinical symptoms. Patients and methods: 20 pediatric patients aged between 1 and 16 years receiving or have received chemotherapy for acute leukemia have undergone MR examination of the brain for evaluation of neurological symptoms related to treatment from August to December 2015. Written consent was taken from the patients. Results: This study included 20 children, 15 (75%) were males and 5 (25%) were females. Their ages at the time of the study ranged from 1 to 16 years. 17 patients (85%) were on maintenance chemotherapy, 2 patients (10%) were on induction and 1 patient (5%) had finished treatment. Multiple complications were recorded by MRI and its correlation to the treatment phase of the cases. All cases of Sino-venous thrombosis and hemorrhage occurred within the maintenance phase. Leukoencephalopathy was divided equally between maintenance and induction phases. Brain atrophy was divided equally between induction and maintenance phases. PRES occurred within the maintenance phase. Most of infection cases (sinusitis and otitis media) occurred within maintenance; only one case was seen in a patient who just ended his chemotherapy. Conclusion: Chemotherapy is associated with certain side effects that can be evaluated by utilization of MRI. An elevated degree of suspicion is needed to recognize the radiological features of CNS complications of chemotherapy and familiarity with the imaging findings is essential for proper diagnosis and further treatment of neurological symptoms in pediatric patients with leukemia.

Keywords

• Childhood
• Leukemia
• Chemotherapy
• Neurotoxicity
• Brain MRI