Article Figures & Data
Figures
- Fig 1.
A 10-year-old boy with fludarabine-related PATL (patient 11). Axial DWI (A) and ADC map (B) show symmetric, extensive, and confluent diffusely reduced diffusion with the corresponding hyperintensity on axial FLAIR (C) and T2WI (D) in the subcortical WM and basal ganglia. The child died 7 days after the insult, with the ATL outcome score being 4 (ie, severe outcome).
- Fig 2.
An 11-year-old boy with methotrexate-induced PATL (patient 5). Axial DWI (A) and ADC map (B) show unilateral reduced diffusion within the deep left frontoparietal PVWM without significant corresponding hyperintensity on an axial FLAIR image (C). The patient had moderate long-term neurologic sequelae, with the ATL outcome score at 1 month being 2. An ADC map (B) illustrates the placement of ROIs for the measurement of ADC values, as well as to determine the %ADCR. Such ROIs were located in the affected WM lesion (red ROI) and nonaffected WM (NAWM) (orange ROI).
- Fig 3.
A boxplot demonstrates the mean FLAIR and DWI severity scores for PATL according to the different subgroups that caused PATL.
- Fig 4.
A boxplot of each etiologic group with the %ADCR of the affected PVWM regions compared with NAWM. Notably, the subgroup of PATL related to chemotherapy had a significantly greater %ADCR compared with the immunosuppression group. PATL from other causes (group O) demonstrated a trend toward greater %ADCR compared with immunosuppression group, but without reaching statistical significance.
- Fig 5.
A scatterplot and regression line, which together display the positive relationship between the FLAIR/DWI severity scores and clinical outcome.
- Fig 6.
A scatterplot and regression line, which together display the positive relationship between the %ADCR and clinical outcome.
Tables
- Table 1:
Brain MR imaging abnormalities, their distribution, locations of reduced diffusion, size of the largest WM lesion, %ADCR values, and clinical outcomes
No. Age (yr) Sex Size (cm) Underlying Dx Etiologies Groups Regions of Red. Diffusion FLAIR Severity DWI Severity %ADC Red. Outcome 1 16 M 4.2 × 2.2 ALL Methotrexate C Fr, CS/CR 1 1 0.32 1 2 14 M 2.1 × 0.8 ALL Methotrexate C Fr, CS/CR 1 1 0.16 0 3 18 M 4.5 × 2.6 ALL Methotrexate C Fr+P, CS/CR 1 2 0.39 2 4 16 F 2.1 × 1.8 ALL Cytarabine C Fr, CS/CR 1 1 0.35 2 5 11 M 4.5 × 2.2 ALL Methotrexate C Fr, CS/CR, CC 0 2 0.36 2 6 11 F 4.1 × 1.8 ALL Methotrexate C Fr+P, CS/CR 1 2 0.41 2 7 14 F D AML Fludarabine C D, CS/CR, CC, Th 4 4 0.32 3 8 17 F 2.3 × 0.4 ALL Methotrexate C Fr+P, CS/CR 2 2 0.32 3 9 1 F 3.8 × 1.1 ATRT Carboplatin C Fr+P, CS/CR, Th 2 3 0.57 4 10 15 F 2.4 × 1.4 PTLD Methotrexate C Fr+P, CS/CR, BS, CC 3 3 0.29 4 11 10 M D AML Fludarabine C D, CS/CR, Th, BS 4 4 0.62 4 12 17 F 5.4 × 2.0 AML Fludarabine C Fr+P, CS/CR 2 2 0.48 4 13 13 F 1.5 × 0.7 JMML BMT I Fr, CS/CR 1 1 0.17 0 14 16 F 2.8 × 0.8 AA BMT I Fr, CS/CR 1 1 0.42 0 15 17 M 1.3 × 1.1 AML Cyclosporine I P, CS/CR 1 1 0.06 1 16 17 F 0 AML BMT I NA 1 0 0.02 0 17 1 M 2.8 × 0.5 RMS BMT I Fr, CS/CR 1 1 0.15 2 18 7 M 3.9 × 1.9 ATRT Bevacizumab O Fr, CS/CR 1 1 0.51 2 19 16 M 7.9 × 2.4 ESRD Uremia O Fr+P, CS/CR 2 2 0.57 3 Note:—AA indicates aplastic anemia; ALL, acute lymphocytic leukemia; AML, acute myeloid leukemia; ATRT, atypical teratoid/rhabdoid tumor; %ADC red., percentage ADC reduction; BS, brain stem; CC, corpus callosum; CR, corona radiata; CS, centrum semiovale; D, diffuse; Dx, diagnosis; ESRD, end-stage renal disease; Fr, frontal; JMML, juvenile myelomonocytic leukemia; NA, not applicable; P, parietal; PTLD, post-transplant lymphoproliferative disorder; RMS, rhabdomyosarcoma; Th, thalami.
- Table 2:
Mean demographics, imaging characteristics, and clinical outcomes according to different subgroups of PATL
Characteristics Group C (n = 12) Group I (n = 5) Group O (n = 2) Total (n = 19) Sex Male (No.) 5 2 2 9 Female (No.) 7 3 0 10 Age (yr) 13.3 12.8 11.5 13 FLAIR severity score 1.8 1 1.5 1.5 DWI severity score 2.25 0.8 1.5 1.78 %ADCR 0.38 0.16 0.54 0.34 Clinical outcomea 2.58 0.6 2.5 2.05 ↵a Four of 19 patients (21%) did not have a >30-day clinical outcome available.
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