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Microstructure alterations in the hypothalamus in cranially radiated childhood leukaemia survivors but not in craniopharyngioma patients unaffected by hypothalamic damage
Author(s) -
Follin Cecilia,
Fjalldal Sigridur,
Svärd Daniel,
Westen Danielle,
Gabery Sanaz,
Petersén Åsa,
Lätt Jimmy,
Rylander Lars,
Erfurth Eva Marie
Publication year - 2017
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/cen.13373
Subject(s) - craniopharyngioma , fractional anisotropy , medicine , endocrinology , diffusion mri , magnetic resonance imaging , radiology
Summary Objective Metabolic complications are frequent in childhood leukaemia ( ALL ) survivors treated with cranial radiotherapy ( CRT ). These complications are potentially mediated by damage to the hypothalamus ( HT ), as childhood onset ( CO ) craniopharyngioma ( CP ) survivors without HT involvement are spared overt obesity. Diffusion tensor imaging ( DTI ) shows brain tissue microstructure alterations, by fractional anisotrophy ( FA ), mean diffusivity ( MD ), axial diffusivity ( AD ) and radial diffusivity ( RD ). We used DTI to determine the integrity of the microstructure of the HT in ALL survivors. Design Case‐control study. Patients Three groups were included: (i) 27 CRT treated ALL survivors on hormone supplementation, (ii) 17 CO ‐ CP survivors on hormone supplementation but without HT involvement and (iii) 27 matched controls. Measurements DTI parameters of the HT were measured and body composition. Results Microstructural alterations in the HT were more severe in ALL survivors with a BMI ≥25 than with BMI <25. Compared to controls, ALL survivors had reduced FA ( P =.04), increased MD ( P <.001), AD ( P <.001) and RD ( P <.001) in the right and left HT . In the right HT , ALL survivors with a BMI ≥25 showed elevated MD ( P =.03) and AD ( P =.02) compared to ALL survivors with BMI <25. In contrast, DTI parameters did not differ between CP survivors and controls. Conclusions Long‐term follow‐up after CRT for ALL DTI measures were affected in the HT despite complete hormone replacement. The present data suggest that ALL survivors have demyelination and axonal loss in the HT .