评估新发儿童急性淋巴细胞白血病患者脑结构变化

Assessing changes in brain structure in new-onset children with acute lymphoblastic leukemia

PEDIATRIC RESEARCH

影响因子:3.1

分区:医学3区 / 儿科2区

发表日期:2025 Jun

作者: Shu Su, Hua-Qiong Qiu, Lian-Hong Cai, Wei-Feng Hou, Shu-Zhen Huang, Li-Bin Huang, Long Qian, Wei Cui, Yian-Qian Chen, Zhi-Yun Yang, Yan-Lai Tang, Li-Ping Lin

DOI: 10.1038/s41390-024-03655-w

摘要

急性淋巴细胞白血病（ALL）治疗后出现脑结构损伤，但其在新发阶段的变化尚不清楚。本研究旨在利用表面形态测量（SBM）和束缚空间统计（TBSS）技术，探讨新发儿童ALL中的白质（WM）和灰质（GM）变化。前瞻性招募了35例ALL患者和33例正常发育（TD）儿童，进行三维T1加权和弥散张量成像（DTI）。比较两组的DTI指标、皮层灰质特征及深部灰质核团体积差异。在ALL患者中，唯一显著增加的FA值位于胼胝体体部（PFWE校正=0.023）和左侧上冠辐射（PFWE校正=0.045）。与正常发育儿童相比，ALL患者在眶回、超缘回、中颞回和上颞回的皮层表面积（CSA）、厚度（CT）和体积均显著降低（全部CWP=0.01）。此外，舌状回和左侧沟间沟的CT和CSA分别增加（全部CWP=0.01）。双侧丘脑、尾状核、海马和右侧苍白球的体积较小（PFDR校正<0.05）。新发儿童ALL显示出广泛的脑结构异常，提示疾病本身可能引起脑结构损伤。本研究揭示了儿童急性淋巴细胞白血病在新发阶段的白质完整性和灰质形态的变化，提示在化疗前可能存在结构性损伤。MRI是一种敏感的早期检测脑结构损伤的方法。

Abstract

Brain structure injury was presented in acute lymphoblastic leukemia (ALL) after treatment; however, its alterations in new-onset stage are still unclear. We aim to explore white matter (WM) and grey matter (GM) alterations using surface-based morphometry (SBM) and tract-based spatial statistics (TBSS) in new-onset pediatric ALL.Thirty-five ALL and 33 typically developing (TD) children were prospectively recruited and underwent three-dimensional T1-weighted and diffusion tensor (DTI) imaging. DTI metrics, cortical GM features, and deep GM nuclei volume were compared between groups differences.In ALL, the only increased FA in the body of corpus callosum (PFWE-corrected = 0.023) and left superior corona radiata (PFWE-corrected = 0.045) were presented. Relative to TDs, pediatric ALL presented a significant decrease in cortical surface area (CSA), thickness (CT), and volume in orbital gyri, supramarginal gyrus, middle temporal gyrus, and superior temporal gyrus (all CWP = 0.01). Additionally, increased CT and CSA were found in lingual gyrus and left sulcus intermedius primus, respectively (all CWP = 0.01). Smaller volumes in pediatric ALL were observed in bilateral thalamus, caudate, hippocampus, and right putamen (PFDR-corrected < 0.05).Widespread brain structural abnormalities were found in new-onset pediatric ALL, which suggest disease itself can cause brain structural injury.This study revealed the altered white matter integrity and gray matter morphology characteristics in childhood acute lymphoblastic leukemia on new-onset stage. It is suggested that there may be structural impairment before chemotherapy. MRI is a sensitive way for early detection on brain structural damage in childhood acute lymphoblastic leukemia.