Evaluation On Skull And Brain Lesions In Children With Acute Leukemia Before And After Induction Chemotherapy

Objective:To investigate the changes in skull and brain lesions in children with acute leukemia(AL) before and after induction chemotherapy by cranial magnetic resonance imaging(MRI) and Wechsler Intelligence Scale test.Methods:73 pediatric patients with AL were hospitalized from March 2014 to June 2015, the clinical data and results of MRI and Wechsler Intelligence Scale test for those people were analyzed before and after induction chemotherapy. Two groups of ALL were defined according to peripheral white blood cells(WBC) count, one group with WBC more than or equal to 20×109/L(high WBC count group, HWCG) and the other group with WBC under 20×109/L(low WBC count group, LWCG). The patients with ALL were divided into high risk group and non-high risk group based on clinical risk stratifications. Participants were performed an age-appropriate Wechsler Intelligence Scale. Chinese Wechsler Young Children Scale of Intelligence(C-WYCSI) was used for patients aged from 4 to 6 years, Chinese Wechsler Intelligence Scale for Children-Third Edition(WISC-III) for patients aged from 6 to 14 years.Results:(1)There were totally 73 patients of AL, including 62 children with ALL and 11 with AML. The patient ages of ALL ranged from 1 to 13, with middle age of 3.2 years old, including 41 males and 21 females, 21 cases(33.9%) for the high risk group and 41 cases(66.1%) for the non-high risk group, 24 cases(38.7%) for the HWCG and 38 cases(61.3%) for the LWCG, 1 case with central nervous system leukemia(CNSL). The children with AML aged from 4 to 14, with middle age of 8 years old, including 5 males and 6 females, 8 cases(72.7%) for the HWCG and 3 cases(27.3%) for the LWCG.(2) Before chemotherapy,MRI showed bone marrow infiltration of the skull(BMIS) in 33 patients(53.2%) of ALL, the children in the HWCG had a significantly higher incidence of BMIS than those in the LWCG(17 patients/70.8% vs 16 patients/42.1%; P<0.05), and the high-risk group had a significantly higher incidence of BMIS than the non-high-risk group(15 patients/71.4% vs 18 patients/43.9%; P<0.05). The patients with BMIS in the non-high-risk group accounted for 29 percent of the patients with ALL, 12 cases reexamined by MRI all had disappearance of BMIS after the induction treatment.(3) Before chemotherapy, there were 4 cases(6.5%) of brain atrophy in children with ALL, and 2 cases(3.2%) of abnormal signals in the sensory conduction bundle. MRI reexamination in 28 patients with ALL after 3 months of chemotherapy showed 3 new cases(10.7%) of brain atrophy and 1 aggravated case of brain atrophy, and the abnormal signal of the sensory conduction bundle all disappeared.(4) Before chemotherapy, there were 4 cases(36.4%) of BMIS in patients with AML, with WBC more than 20×109/L.(5) MRI reexamination in 4 patients with AML after 3 months of chemotherapy showed 1 case of intracranial hemorrhage, and BMIS in 2 cases disappeared.(6) 16 cases before chemotherapy and 15 cases after chemotherapy conducted Wechsler Intelligence Scale test. Before chemotherapy, the scores of FIQ were 95±13, VIQ 93±15, and PIQ 99±12. After chemotherapy, the scores of FIQ were 97±13, VIQ 95±15, and PIQ 99±13. There was no statistic significance comparing with 60 cases of healthy children(FIQ 100±5、VIQ 100±8、PIQ 100±9). But the incidence of border intelligence in children with AL was higher than that of the healthy children.Conclusions:(1) The children with ALL had BMIS, brain atrophy, and abnormal signals in the sensory conduction bundle before chemotherapy, especially BMIS. Most of the abnormal images disappeared after induction treatment, with new emerged or aggravated brain atrophy.(2) The children with WBC≥20×109/L and in the high-risk group of ALL had a significantly higher incidence of BMIS.(3) The patients with BMIS in the non-high-risk group accounted for 29 percent of the patients with ALL. It’s necessary to evaluate the long-term survival of the ALL patients with BMIS in the non-high risk group so as to estimate the significance of early MRI in the risk assessment of ALL before treatment.(4) The children with AML had BMIS before chemotherapy, especially in the patients with WBC more than 20×109/L. BMIS disappeared after induction treatment, with new emerged intracranial hemorrhage.(5) The IQ scores of the children with AL had no significant decrease after induction chemotherapy. The cranial MRI can detect the changes of brain lesions in children with AL more sensitively than Wechsler Intelligence Scale test.