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目的探讨急性淋巴细胞白血病(ALL)儿童因使用甲氨蝶呤(MTX)出现的急性脑病的临床及影像学特点。方法 2005-07-01—2009-08-31首都医科大学附属北京儿童医院血液病中心收治的ALL患儿637例,回顾性分析应用MTX后发生急性脑病病例的临床和影像学资料。结果 7例患儿应用MTX后3～10 d发生急性脑病,主要表现为偏瘫、全身抽搐、言语不利、单侧肢体无力和面瘫,予对症治疗后3～5 d内缓解。急性脑病的发生与MTX剂量、患儿年龄和MTX代谢有关。4例患儿弥散加权成像(DWI)表现为深部白质的弥散受限,以半卵圆中心和放射冠区为著。结论 MTX诱发的急性脑病主要表现为一过性、局灶性运动功能损害,DWI的弥散受限是MTX诱发急性脑病诊断的敏感手段。
Objective To investigate the clinical and imaging features of acute encephalopathy in children with acute lymphoblastic leukemia (ALL) due to the use of methotrexate (MTX). Methods A total of 637 children with ALL were enrolled in Department of Hematology, Beijing Children ’s Hospital Affiliated to Capital Medical University. The clinical and imaging data of cases with acute encephalopathy after MTX were retrospectively analyzed. Results Seven children developed acute encephalopathy 3 ~ 10 days after MTX. The main manifestations were hemiplegia, generalized convulsions, poor speech, unilateral limb weakness and facial paralysis, and were relieved within 3 to 5 days after symptomatic treatment. The incidence of acute encephalopathy and MTX dose, children’s age and MTX metabolism. Diffuse weighted imaging (DWI) in 4 children manifested as limited diffusion of deep white matter, with the semi-oval center and corona radiata. Conclusion MTX-induced acute encephalopathy is mainly characterized by transient and focal motor function impairment. The limited diffusion of DWI is a sensitive measure for the diagnosis of acute encephalopathy induced by MTX.