MRI in methotrexate-related leukoencephalopathy: Disseminated necrotising leukoencephalopathy in comparison with mild leukoencephalopathy

被引:40
作者
Oka, M
Terae, S
Kobayashi, R
Sawamura, Y
Kudoh, K
Tha, KK
Yoshida, M
Kaneda, M
Suzuki, Y
Miyasaka, K
机构
[1] Hokkaido Grad Univ Sch Med, Dept Radiol, Sapporo, Hokkaido 0608638, Japan
[2] Hokkaido Grad Univ Sch Med, Dept Paediat, Sapporo, Hokkaido 0608638, Japan
[3] Hokkaido Grad Univ Sch Med, Dept Neurosurg, Sapporo, Hokkaido 0608638, Japan
关键词
methotrexate; leukoencephalopathy; magnetic resonance imaging; contrast enhancement;
D O I
10.1007/s00234-003-0983-3
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
We report two fatal cases of methotrexate (MTX)-induced disseminated necrotising leukoencephalopathy (DNL) in which MRI was repeated from the onset. Initial T2-weighted images showed multiple areas of high signal, mainly in deep cerebral white matter, which on follow-up, spread and coalesced to involve the entire white matter. Small irregular low-signal foci on T2-weighted images were seen within the high-signal lesions. Multiple areas of contrast enhancement corresponded to these low-signal foci. The condition of both patients deteriorated and they died. We compared their MRI findings with those of seven patients with mild MTX-related leukoencephalopathy, six of whom were asymptomatic; one had transient neurological symptoms. They showed no contrast enhancement, but rather mild-to-moderate diffuse high signal in deep white matter, which later disappeared. These findings suggest that multiple low-signal foci on T2-weighted images with contrast enhancement may be characteristic of DNL, and that contrast-enhanced imaging is useful to differentiate this condition from mild leukoencephalopathy.
引用
收藏
页码:493 / 497
页数:5
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