Background

Advances in hematopoietic stem cell transplantation have improved the survival rate of malignant diseases and congenital immunodeficiencies. It has become important to assess long-term complications in survivors. To assess neurological abnormalities in children treated by transplantation, diffusion tensor imaging was performed.

Methods

Forty children who underwent head diffusion tensor imaging before and after their first transplantation were enrolled. Patients with brain lesions on conventional MRI were excluded. Fractional anisotropy and mean diffusivity were compared between patients and 28 control subjects using tract-based spatial statistics. The Strengths and Difficulties Questionnaire was administered as a behavioral evaluation after transplantation, and diffusion tensor images of patients with and without behavioral abnormalities were compared.

Results

The age of patients and controls was 0 to 19 years and 0 to 16 years, respectively. The date of diffusion tensor imaging was 10 to 57 days before and 40 to 153 days after transplantation. Tract-based spatial statistics showed fractional anisotropy reduction in widespread white matter in patients before and after transplantation. Mean diffusivity was high before transplantation and normalized after transplantation. Analysis comparing before and after hematopoietic stem cell transplantation shows no difference in fractional anisotropy and significantly high mean diffusivity before hematopoietic stem cell transplantation. In patients with behavioral abnormalities, low fractional anisotropy and high mean diffusivity remained after transplantation.

Conclusions

Longitudinal diffusion tensor imaging showed white matter abnormalities in children without conventional MRI abnormalities, which were related to behavioral problems after transplantation. Diffusion tensor imaging is useful for behavioral assessment in children undergoing transplantation.

中文翻译：

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造血干细胞移植患儿白色物质完整性的变化。

背景

造血干细胞移植的进展提高了恶性疾病和先天性免疫缺陷的存活率。评估幸存者的长期并发症已变得很重要。为了评估接受移植治疗的儿童的神经系统异常，进行了弥散张量成像。

方法

入选40例在首次移植之前和之后接受脑弥散张量成像的儿童。排除常规MRI脑损伤患者。使用基于区域的空间统计数据比较了患者和28位对照受试者的分数各向异性和平均扩散率。在移植后进行强度和困难问卷调查，作为行为评估，比较有无行为异常患者的弥散张量图像。

结果

患者和对照组的年龄分别为0至19岁和0至16岁。弥散张量成像的日期为移植前10至57天和移植后40至153天。基于区域的空间统计数据显示，移植前后患者广泛分布的白质中的各向异性有所降低。移植前平均扩散率高，移植后恢复正常。对比造血干细胞移植前后的分析表明，造血干细胞移植之前的分数各向异性无差异，并且平均扩散率明显较高。在行为异常的患者中，移植后仍然存在较低的分数各向异性和较高的平均扩散率。

结论

纵向扩散张量成像显示患儿无常规MRI异常的白质异常，这与移植后的行为问题有关。扩散张量成像可用于接受移植的儿童的行为评估。