The Impact of Persistent Leukoencephalopathy on Brain White Matter Microstructure in Long-Term Survivors of Acute Lymphoblastic Leukemia Treated with Chemotherapy Only

Association between white matter integrity and global neurocognitive impairment. Black circles represent survivors with global neurocognitive impairment. White circles represent survivors without global neurocognitive impairment. Global neurocognitive impairment is defined as having ≥2 neurocognitive tests (listed in On-line Table 3) that fall >1.5 SDs or 1 test that falls >2 SDs below the age-adjusted population normative data. The y-axis represents mean diffusivity. Higher mean diffusivity is indicative of worse white matter integrity. Error bars represent the 95% confidence intervals. P values compare the mean diffusivity between survivors with neurocognitive impairment (closed circle, n = 63) and without neurocognitive impairment (open circle, n = 87) using general linear modeling, adjusted for current age. The image shows that survivors with neurocognitive impairment had reduced white matter integrity demonstrated by higher global mean diffusivity in the corona radiata and superior fronto-occipital fasciculus. Details on the associations between global neurocognitive impairment and lateralized diffusion tensor imaging measures within the specific tracts can be found in On-line Table 4.