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Microstructure alterations in the hypothalamus in cranially radiated childhood leukaemia survivors but not in craniopharyngioma patients unaffected by hypothalamic damage

Follin, Cecilia LU ; Fjalldal, Sigridur LU ; Svärd, Daniel LU ; van Westen, Danielle LU orcid ; Gabery, Sanaz LU ; Petersén, Åsa LU ; Lätt, Jimmy LU ; Rylander, Lars LU orcid and Erfurth, Eva Marie LU (2017) In Clinical Endocrinology 87(4). p.359-366
Abstract

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... (More)

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.

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author
; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Childhood craniopharyngioma, Childhood leukaemia, Cranial radiotherapy, Diffusion tensor imaging, Hypothalamus
in
Clinical Endocrinology
volume
87
issue
4
pages
359 - 366
publisher
Wiley-Blackwell
external identifiers
  • pmid:28502079
  • wos:000409274700007
  • scopus:85020872675
ISSN
0300-0664
DOI
10.1111/cen.13373
language
English
LU publication?
yes
id
35b09a2b-76fb-4be7-9c8c-1d16669306b7
date added to LUP
2017-08-22 11:10:14
date last changed
2025-01-07 19:04:05
@article{35b09a2b-76fb-4be7-9c8c-1d16669306b7,
  abstract     = {{<p>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 &lt;25. Compared to controls, ALL survivors had reduced FA (P=.04), increased MD (P&lt;.001), AD (P&lt;.001) and RD (P&lt;.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 &lt;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.</p>}},
  author       = {{Follin, Cecilia and Fjalldal, Sigridur and Svärd, Daniel and van Westen, Danielle and Gabery, Sanaz and Petersén, Åsa and Lätt, Jimmy and Rylander, Lars and Erfurth, Eva Marie}},
  issn         = {{0300-0664}},
  keywords     = {{Childhood craniopharyngioma; Childhood leukaemia; Cranial radiotherapy; Diffusion tensor imaging; Hypothalamus}},
  language     = {{eng}},
  month        = {{05}},
  number       = {{4}},
  pages        = {{359--366}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Clinical Endocrinology}},
  title        = {{Microstructure alterations in the hypothalamus in cranially radiated childhood leukaemia survivors but not in craniopharyngioma patients unaffected by hypothalamic damage}},
  url          = {{http://dx.doi.org/10.1111/cen.13373}},
  doi          = {{10.1111/cen.13373}},
  volume       = {{87}},
  year         = {{2017}},
}