目的 探讨急性淋巴细胞白血病（简称急淋）伴化疗药物相关脑损伤的类型、临床和影像学特点及预后情况，以提高临床医师对该类脑损伤的认识。方法 回顾性分析2015年6月至2023年6月仅接受化疗后发生化疗药物相关脑损伤的急淋患儿的临床资料。结果 纳入化疗药物相关脑损伤患儿46例，男24例、女22例。急淋发病中位年龄为5.6（3.7~10.2）岁；化疗后发生脑损伤的中位年龄为6.6（4.7~10.3）岁。首次全身化疗后，经过2.0（1.0~8.0）个月首次出现脑损伤，其中脑病34例（73.9%）、神经血管并发症9例（19.6%）、孤立性神经系统症状3例（6.5%）。38例患儿出现神经系统症状，以癫痫发作最为常见（26例），其次为头昏或头痛、瘫痪、视觉障碍等。脑病患儿病灶主要分布在侧脑室周围及半卵圆中心、顶叶、枕叶、额叶等部位；神经血管并发症主要表现为颅内出血及脑血栓形成，其中静脉血栓形成部位以上矢状窦最常见。38例有明显神经系统症状患儿中，30例临床症状改善较快，预后良好。随访至22个月，32例神经影像学异常患儿中29例经复查提示好转。结论 急淋伴化疗药物相关脑损伤的临床和神经影像学表现多样，总体预后较好，极少患儿可有症状性癫痫后遗症；早期神经影像学检查有助于脑损伤早发现及早干预，更好优化急淋治疗。

Objective To investigate the types, clinical and imaging features and prognosis of chemotherapy-related cerebral lesion in acute lymphoblastic leukemia (ALL), so as to improve the clinicians' understanding of this kind of brain injury. Methods The clinical data of children with ALL who developed chemotherapy-related cerebral lesion after receiving chemotherapy alone from June 2015 to June 2023 were retrospectively analyzed. Results A total of 46 children (24 boys and 22 girls) with chemotherapy-related cerebral lesion were enrolled. The median onset age of ALL was 5.6(3.7-10.2) years old. The median age of children with cerebral lesion treated by chemotherapy was 6.6(4.7-10.3) years old. First cerebral lesion occurred 2.0(1.0-8.0) months after the first systemic chemotherapy, including 34 cases (73.9%) of encephalopathy, 9 cases (19.6%) of neurovascular complications, and 3 cases (6.5%) of isolated neurological symptoms. Neurological symptoms occurred in 38 children. Seizures were the most common (26 cases), followed by dizziness or headache, paralysis, visual disturbance, etc. The lesions in children with encephalopathy were mainly distributed around the lateral ventricles, semi-oval center, the parietal lobe, the occipital lobe, and the frontal lobe. The main neurovascular complications were intracranial hemorrhage and cerebral thrombosis, among which the superior sagittal sinus was the most common site of venous thrombosis.Among 38 patients with obvious neurological symptoms, 30 patients showed rapid improvement in clinical manifestations and had a good prognosis. At the follow-up of 22 months, 29 of the 32 children with neuroimaging abnormalities showed improvement after review. Conclusions The clinical and neuroimaging manifestations of ALL with chemotherapy-related cerebral lesion were diverse, and the overall prognosis was good. Few children had symptomatic epilepsy sequelae. Early neuroimaging is helpful for early detection and intervention of cerebral lesion and better optimization of ALL treatment.