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Voxel-based analysis of T2 hyperintensities in white matter during treatment of childhood leukemia
American Journal of Neuroradiology, 08/07/09

Reddick WE et al. – In a study using voxel-based analyses (VBA) of T2-weighted imaging of pts during treatment to identify which white matter (WM) regions are preferentially damaged, the analyses identified specific WM tracts involving predominantly the anterior, superior, and posterior corona radiata and superior longitudinal fasciculus, which were at increased risk for development of T2-weighted hyperintensities during therapy for childhood acute lymphoblastic leukemia (ALL). These vulnerable regions may be the cause of subsequent cognitive difficulties consistently observed in survivors.

Methods

2 sets of conventional T2-weighted axial images were acquired on a 1.5T MR imaging scanner from 197 consecutive pts (85 female, 112 male; aged 1.0–18.9 yrs) enrolled on an ALL treatment protocol.
Images were acquired after completion of induction therapy and after the final of 4 courses of intravenous high-dose methotrexate in consolidation therapy (3.9 ± 0.8 mos apart).
Voxel-wise statistical testing of incremental change between normalized longitudinal T2 images was performed with radiologist reading (normal or abnormal) and treatment risk-group as covariates.

Results

2 highly significant bilateral clusters of T2 signal intensity change were identified in both 1-group and 2-group analyses.
The regions were symmetric 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 examinations was greater for older subjects who received more intense therapy.

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