MAGNETIC-RESONANCE-IMAGING OF THE BRAIN AND NEUROPSYCHOLOGICAL EVALUATION IN CHILDREN TREATED FOR ACUTE LYMPHOBLASTIC-LEUKEMIA AT A YOUNG AGE

Purpose: To evaluate the adverse late effects of ALL treatment on cogn itive functions and brain morphology; to integrate the results of a ne uropsychological and neuroradiological study. Patients and Methods: Cr anial magnetic resonance imaging (MRI) and neuropsychological assessme nts (NA) were performed in 35 children treated for acute lymphoblastic leukemia (ALL) with cranial irradiation (CI) and intrathecal and intr avenous methotrexate. Patients were under the age of 7 years (MD: 3.5 years) at diagnosis; median follow-up at MRI and NA was 8 years since diagnosis. Results: MRI's were classified as definitely abnormal in 51 % and as probably abnormal in another 17% of the patients. White matte r damage was most frequently seen. MRI abnormalities were not related to CI dose or age at diagnosis. Patients showed significantly lower sc ores, compared to the norm group on measures of intelligence, verbal a uditory memory, visual motor integration, and fine motor functioning. Lower scores significantly correlated with higher CI dose (25-32 Gy co mpared to 18-20 Gy) and younger age at diagnosis (<4.0 years compared to greater-than-or-equal-to 4.0 years). Forty percent of the patients had to be referred to schools for learning disabled. Conclusions: ALL treatment, including CI and MTX, at a young age is associated with per sistent cognitive impairment and MRI abnormalities. However, no correl ation was found between MRI results and neuropsychological or academic performance.