Abstract: Objective To investigate the clinical and neuroimaging features of childhood acute lymphoblastic leukemia (ALL) complicated with leukoencephalopathy, so as to improve the understanding of it. Methods The clinical data of 28 children with ALL who developed leukoencephalopathy from May 2011 to April 2021 were retrospectively analyzed. Results Among the 28 patients, there were 18 boys and 10 girls. The median onset age of ALL was 6 . 63 ( 1 . 37 - 12 . 87 ) years, and the median onset age of leukoencephalopathy was 7 . 81 ( 1 . 45 - 14 . 01 ) years. Neurological manifestations were found in 24 children, and the main symptoms were epileptic seizure ( 13 cases), paralysis ( 8 cases), limb numbness ( 6 cases), visual impairment ( 6 cases) and slurred speech ( 4 cases). On neuroimaging, the lesions were mainly distributed in the parietal lobe ( 10 cases), periventricular and central white matter area of semicovale ( 9 cases), basal ganglia ( 6 cases), frontal lobe ( 4 cases) and occipital lobe ( 4 cases). The lesions were multiple and irregular, distributed in small or large patches. After the occurrence of ALL with leukoencephalopathy, chemotherapy drugs were stopped immediately and symptomatic treatment was given, and the clinical symptoms and imaging lesions gradually disappeared in most cases. During the 1 -year follow-up, 19 of the 28 cases were re-examined with head MRI, 16 cases ( 84 . 2 %) showed significant improvement in lesions compared with the first time, and 11 cases ( 57 . 9 %) showed complete disappearance of abnormal signals. Conclusions Leukoencephalopathy may be an important complication during the treatment of ALL. Although the clinical and radiographic manifestations of ALL with leukoencephalopathy are diverse, children with early diagnosis and treatment have better prognoses when neurological symptoms occur.

Key words: acute lymphoblastic leukemia; leukoencephalopathy; clinical feature; image characteristics; child