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Brain white matter lesions are associated with reduced hypothalamic volume and cranial radiotherapy in childhood-onset craniopharyngioma

Fjalldal, Sigridur LU ; Rylander, Lars LU orcid ; van Westen, Danielle LU orcid ; Holmer, Helene LU ; Follin, Cecilia LU ; Gabery, Sanaz LU ; Petersen, Åsa LU and Erfurth, Eva Marie LU (2021) In Clinical Endocrinology 94(1). p.48-57
Abstract

Context: White matter lesions (WML) are caused by obstruction of small cerebral vessels associated with stroke risk. Craniopharyngioma (CP) patients suffer from increased cerebrovascular mortality. Objective: To investigate the effect of reduced HT volume and cranial radiotherapy (CRT) on WML in childhood-onset CP patients. Design: A cross-sectional study of 41 patients (24 women) surgically treated childhood-onset CP in comparison to controls. Setting: The South Medical Region of Sweden (2.5 million inhabitants). Methods: With magnetic resonance imaging (MRI), we analysed qualitative measurement of WML based on the visual rating scale of Fazekas and quantitative automated segmentation of WML lesion. Also, measurement HT volume and of... (More)

Context: White matter lesions (WML) are caused by obstruction of small cerebral vessels associated with stroke risk. Craniopharyngioma (CP) patients suffer from increased cerebrovascular mortality. Objective: To investigate the effect of reduced HT volume and cranial radiotherapy (CRT) on WML in childhood-onset CP patients. Design: A cross-sectional study of 41 patients (24 women) surgically treated childhood-onset CP in comparison to controls. Setting: The South Medical Region of Sweden (2.5 million inhabitants). Methods: With magnetic resonance imaging (MRI), we analysed qualitative measurement of WML based on the visual rating scale of Fazekas and quantitative automated segmentation of WML lesion. Also, measurement HT volume and of cardiovascular risk factors were analysed. Results: Patients had a significant increase in WML volume (mL) (P =.001) compared to controls. Treatment with cranial radiotherapy (CRT) vs no CRT was associated with increased WML volume (P =.02) as well as higher Fazekas score (P =.001). WML volume increased with years after CRT (r = 0.39; P =.02), even after adjustment for fat mass and age. A reduced HT volume was associated with increased WML volume (r = −0.61, P <.001) and explained 26% of the variation (r2 = 0.26). Altogether, 47% of the WML volume was explained by age at investigation, HT volume and CRT. Patients with more WML also had higher cardiovascular risk. Conclusions: CRT may be associated directly with increased WML volume or indirectly with reduced HT volume associated with higher cardiovascular risk. Risk factors should be carefully monitored in these patients.

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author
; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
craniopharyngioma, hypothalamic lesion, hypothalamic volume, radiotherapy, white matter lesions
in
Clinical Endocrinology
volume
94
issue
1
pages
10 pages
publisher
Wiley-Blackwell
external identifiers
  • scopus:85096655816
  • pmid:32762072
ISSN
0300-0664
DOI
10.1111/cen.14307
language
English
LU publication?
yes
id
04b0b782-fa7b-4433-968c-d48c30ce7328
date added to LUP
2020-12-07 13:56:34
date last changed
2024-04-17 20:30:50
@article{04b0b782-fa7b-4433-968c-d48c30ce7328,
  abstract     = {{<p>Context: White matter lesions (WML) are caused by obstruction of small cerebral vessels associated with stroke risk. Craniopharyngioma (CP) patients suffer from increased cerebrovascular mortality. Objective: To investigate the effect of reduced HT volume and cranial radiotherapy (CRT) on WML in childhood-onset CP patients. Design: A cross-sectional study of 41 patients (24 women) surgically treated childhood-onset CP in comparison to controls. Setting: The South Medical Region of Sweden (2.5 million inhabitants). Methods: With magnetic resonance imaging (MRI), we analysed qualitative measurement of WML based on the visual rating scale of Fazekas and quantitative automated segmentation of WML lesion. Also, measurement HT volume and of cardiovascular risk factors were analysed. Results: Patients had a significant increase in WML volume (mL) (P =.001) compared to controls. Treatment with cranial radiotherapy (CRT) vs no CRT was associated with increased WML volume (P =.02) as well as higher Fazekas score (P =.001). WML volume increased with years after CRT (r = 0.39; P =.02), even after adjustment for fat mass and age. A reduced HT volume was associated with increased WML volume (r = −0.61, P &lt;.001) and explained 26% of the variation (r<sup>2</sup> = 0.26). Altogether, 47% of the WML volume was explained by age at investigation, HT volume and CRT. Patients with more WML also had higher cardiovascular risk. Conclusions: CRT may be associated directly with increased WML volume or indirectly with reduced HT volume associated with higher cardiovascular risk. Risk factors should be carefully monitored in these patients.</p>}},
  author       = {{Fjalldal, Sigridur and Rylander, Lars and van Westen, Danielle and Holmer, Helene and Follin, Cecilia and Gabery, Sanaz and Petersen, Åsa and Erfurth, Eva Marie}},
  issn         = {{0300-0664}},
  keywords     = {{craniopharyngioma; hypothalamic lesion; hypothalamic volume; radiotherapy; white matter lesions}},
  language     = {{eng}},
  number       = {{1}},
  pages        = {{48--57}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Clinical Endocrinology}},
  title        = {{Brain white matter lesions are associated with reduced hypothalamic volume and cranial radiotherapy in childhood-onset craniopharyngioma}},
  url          = {{http://dx.doi.org/10.1111/cen.14307}},
  doi          = {{10.1111/cen.14307}},
  volume       = {{94}},
  year         = {{2021}},
}