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Pediatric Acute Toxic Leukoencephalopathy: Prediction of the Clinical Outcome by FLAIR and DWI for Various Etiologies.
AJNR Am J Neuroradiol. 2020 Jul 02 [Online ahead of print]AA

Abstract

BACKGROUND AND PURPOSE

Pediatric acute toxic leukoencephalopathy is a clinicoradiologic entity comprising various etiologies. This study aimed to identify the MR imaging appearance of pediatric acute toxic leukoencephalopathy from various etiologies and determine whether the etiology correlates with clinical outcome.

MATERIALS AND METHODS

We retrospectively reviewed the electronic records of patients with pediatric acute toxic leukoencephalopathy younger than 19 years of age who had MR imaging within <2 weeks of presentation, including DWI and FLAIR sequences. Two neuroradiologists scored the DWI and FLAIR severity and measured the percentage ADC reduction within the visibly affected regions and normal-appearing WM. The percentage ADC reduction and DWI and FLAIR severity were correlated with clinical outcome using the Spearman correlation.

RESULTS

Of 22 children, 3 were excluded due to a nontoxic cause or incomplete examination. Regarding the included 19 children (mean age, 13 years), the etiologies of pediatric acute toxic leukoencephalopathy were the following: methotrexate (n = 6), bone marrow transplantation (n = 4), fludarabine (n = 3), cytarabine (n = 1), carboplatin (n = 1), vincristine (n = 1), cyclosporine (n = 1), uremia (n = 1), and bevacizumab (n = 1). Three subgroups were analyzed (chemotherapy, n = 12; immunosuppression, n = 5; others, n = 2). There was a strong correlation of FLAIR (r = 0.773, P < .001) and DWI (r = 0.851, P < .001) severity with clinical outcome, and patients treated with fludarabine had the worst outcomes. High percentage ADC reduction values were associated with adverse outcomes, and lower percentage ADC reduction values were associated with favorable outcomes (r = 0.570, P = .011).

CONCLUSIONS

The DWI and FLAIR severity scores appear highly prognostic, whereas percentage ADC reduction is moderately prognostic for clinical outcomes in pediatric acute toxic leukoencephalopathy. Immunosuppressive pediatric acute toxic leukoencephalopathy tends toward favorable outcomes, and fludarabine tends toward worse outcomes.

Authors+Show Affiliations

From the Department of Radiology, University of Minnesota, Minneapolis, Minnesota. oztur027@umn.edu.From the Department of Radiology, University of Minnesota, Minneapolis, Minnesota.From the Department of Radiology, University of Minnesota, Minneapolis, Minnesota.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32616577

Citation

Ozturk, K, et al. "Pediatric Acute Toxic Leukoencephalopathy: Prediction of the Clinical Outcome By FLAIR and DWI for Various Etiologies." AJNR. American Journal of Neuroradiology, 2020.
Ozturk K, Rykken J, McKinney AM. Pediatric Acute Toxic Leukoencephalopathy: Prediction of the Clinical Outcome by FLAIR and DWI for Various Etiologies. AJNR Am J Neuroradiol. 2020.
Ozturk, K., Rykken, J., & McKinney, A. M. (2020). Pediatric Acute Toxic Leukoencephalopathy: Prediction of the Clinical Outcome by FLAIR and DWI for Various Etiologies. AJNR. American Journal of Neuroradiology. https://doi.org/10.3174/ajnr.A6624
Ozturk K, Rykken J, McKinney AM. Pediatric Acute Toxic Leukoencephalopathy: Prediction of the Clinical Outcome By FLAIR and DWI for Various Etiologies. AJNR Am J Neuroradiol. 2020 Jul 2; PubMed PMID: 32616577.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pediatric Acute Toxic Leukoencephalopathy: Prediction of the Clinical Outcome by FLAIR and DWI for Various Etiologies. AU - Ozturk,K, AU - Rykken,J, AU - McKinney,A M, Y1 - 2020/07/02/ PY - 2020/03/19/received PY - 2020/04/30/accepted PY - 2020/7/4/entrez JF - AJNR. American journal of neuroradiology JO - AJNR Am J Neuroradiol N2 - BACKGROUND AND PURPOSE: Pediatric acute toxic leukoencephalopathy is a clinicoradiologic entity comprising various etiologies. This study aimed to identify the MR imaging appearance of pediatric acute toxic leukoencephalopathy from various etiologies and determine whether the etiology correlates with clinical outcome. MATERIALS AND METHODS: We retrospectively reviewed the electronic records of patients with pediatric acute toxic leukoencephalopathy younger than 19 years of age who had MR imaging within <2 weeks of presentation, including DWI and FLAIR sequences. Two neuroradiologists scored the DWI and FLAIR severity and measured the percentage ADC reduction within the visibly affected regions and normal-appearing WM. The percentage ADC reduction and DWI and FLAIR severity were correlated with clinical outcome using the Spearman correlation. RESULTS: Of 22 children, 3 were excluded due to a nontoxic cause or incomplete examination. Regarding the included 19 children (mean age, 13 years), the etiologies of pediatric acute toxic leukoencephalopathy were the following: methotrexate (n = 6), bone marrow transplantation (n = 4), fludarabine (n = 3), cytarabine (n = 1), carboplatin (n = 1), vincristine (n = 1), cyclosporine (n = 1), uremia (n = 1), and bevacizumab (n = 1). Three subgroups were analyzed (chemotherapy, n = 12; immunosuppression, n = 5; others, n = 2). There was a strong correlation of FLAIR (r = 0.773, P < .001) and DWI (r = 0.851, P < .001) severity with clinical outcome, and patients treated with fludarabine had the worst outcomes. High percentage ADC reduction values were associated with adverse outcomes, and lower percentage ADC reduction values were associated with favorable outcomes (r = 0.570, P = .011). CONCLUSIONS: The DWI and FLAIR severity scores appear highly prognostic, whereas percentage ADC reduction is moderately prognostic for clinical outcomes in pediatric acute toxic leukoencephalopathy. Immunosuppressive pediatric acute toxic leukoencephalopathy tends toward favorable outcomes, and fludarabine tends toward worse outcomes. SN - 1936-959X UR - https://www.unboundmedicine.com/medline/citation/32616577/Pediatric_Acute_Toxic_Leukoencephalopathy:_Prediction_of_the_Clinical_Outcome_by_FLAIR_and_DWI_for_Various_Etiologies L2 - http://www.ajnr.org/cgi/pmidlookup?view=long&amp;pmid=32616577 DB - PRIME DP - Unbound Medicine ER -
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