Role of diffusion kurtosis imaging for detecting brain microstructural changes in complete remission childhood survivors undergoing chemotherapy for acute lymphoblastic leukemia

Abstract Objectives Some children with acute lymphoblastic leukemia receiving chemotherapy may sustain brain microstructural damages that impair their neurocognitive function and affect their quality of life to varying degrees. This study aims to determine whether diffusion kurtosis imaging could detect brain microstructural changes in newly diagnosed acute lymphoblastic leukemia patients before and after normalization in complete remission after chemotherapy. Methods Twenty newly diagnosed patients with acute lymphoblastic leukemia and 20 healthy controls matched by sex and were enrolled in this study in the Shenzhen Children's Hospital from August 2019 to December 2020. Head MRI scans were performed mean kurtosis, axial kurtosis and radial kurtosis values were calculated before and after complete remission. Results There were significant decreases observed in mean kurtosis and axial kurtosis in both the genu and splenium of the corpus callosum after chemotherapy among patients under 5 years old who have also achieved complete remission. The diffusion kurtosis imaging parameters were measured in the bilateral frontal lobe and corpus callosum; there were no obvious changes observed among patients older than 5 years old. Conclusion Brain microstructure damage can occur in patients with acute lymphoblastic leukemia during the early stage of chemotherapy. The location of the damage is significantly correlated with the patient’s age. Early recognition of changes in diffusion kurtosis imaging parameters of brain microstructure damage in acute lymphoblastic leukemia patients may help improve patient prognosis.