Semiquantitative analysis of hypothalamic damage on MRI predicts risk for hypothalamic obesity

• Published in: Obesity (Silver Spring, Md.) Vol. 23; no. 6; pp. 1226 - 1233
• Main Authors: Roth, Christian L., Eslamy, Hedieh, Werny, David, Elfers, Clinton, Shaffer, Michele L., Pihoker, Catherine, Ojemann, Jeffrey, Dobyns, William B.
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01.06.2015; John Wiley and Sons Inc
• Subjects: Adolescent; Body Mass Index; Child; Children & youth; Craniopharyngioma - complications; Craniopharyngioma - surgery; Female; Gastrointestinal surgery; Growth hormones; Humans; Hydrocephalus - pathology; Hypothalamic Diseases - etiology; Hypothalamic Diseases - pathology; Hypothalamus - pathology; Magnetic Resonance Imaging; Male; Medical imaging; Mortality; Obesity; Original; Pediatric Obesity - etiology; Pituitary gland; Pituitary Neoplasms - complications; Pituitary Neoplasms - surgery; Retrospective Studies; Risk Assessment; Rodents; Studies; Tumors; Weight Gain
• ISSN: 1930-7381; 1930-739X; 1930-739X
• DOI: 10.1002/oby.21067

Objective Excessive weight gain frequently occurs in patients with hypothalamic tumors and lesions leading to hypothalamic obesity (HO). Methods Digital brain magnetic resonance imaging (MRI) and clinical outcomes were studied retrospectively in a single center, including 45 children with postoperative lesions in the sellar region (41 craniopharyngiomas, 4 with Rathke's cleft cysts), ∼5 years post‐surgery, mean age 13.9 years. Four standard sections covering hypothalamic areas critical to energy homeostasis were used to assess lesions and calculate a hypothalamic lesion score (HLS); the association with HO was examined. Results Compared to subjects who did not develop HO (n = 23), subjects with HO (n = 22) showed more frequently lesions affecting the third ventricular floor, mammillary bodies, and anterior, medial (all P < 0.05), and most importantly posterior hypothalamus (P < 0.01). The HLS correlated significantly with BMI z‐score changes 12 and 30 months post‐surgery, even after adjusting for potential confounders of gender, age at surgery, surgery date, surgery BMI z‐score, hydrocephalus, and residual hypothalamic tumor (r = 0.34, P = 0.03; r = 0.40, P = 0.02, respectively). Diabetes insipidus was found to be an endocrine marker for HO risk. Conclusions The extent of damage following surgery in the sellar region can be assessed by MRI using a novel scoring system for early HO risk assessment.