Department of EndocrinologySkåne University Hospital, Lund, Sweden.
Department of Diagnostic RadiologyClinical Sciences.
Eur J Endocrinol. 2018 Jun;178(6):577-587. doi: 10.1530/EJE-18-0081. Epub 2018 Mar 29.
Patients with craniopharyngioma (CP) and hypothalamic lesions (HL) have cognitive deficits. Which neural pathways are affected is unknown.
To determine whether there is a relationship between microstructural white matter (WM) alterations detected with diffusion tensor imaging (DTI) and cognition in adults with childhood-onset CP.
A cross-sectional study with a median follow-up time of 22 (6-49) years after operation.
The South Medical Region of Sweden (2.5 million inhabitants).
Included were 41 patients (24 women, ≥17 years) surgically treated for childhood-onset CP between 1958-2010 and 32 controls with similar age and gender distributions. HL was found in 23 patients.
Subjects performed cognitive tests and magnetic resonance imaging, and images were analyzed using DTI of uncinate fasciculus, fornix, cingulum, hippocampus and hypothalamus as well as hippocampal volumetry.
Right uncinate fasciculus was significantly altered ( ≤ 0.01). Microstructural WM alterations in left ventral cingulum were significantly associated with worse performance in visual episodic memory, explaining approximately 50% of the variation. Alterations in dorsal cingulum were associated with worse performance in immediate, delayed recall and recognition, explaining 26-38% of the variation, and with visuospatial ability and executive function, explaining 19-29%. Patients who had smaller hippocampal volume had worse general knowledge ( = 0.028), and microstructural WM alterations in hippocampus were associated with a decline in general knowledge and episodic visual memory.
A structure to function relationship is suggested between microstructural WM alterations in cingulum and in hippocampus with cognitive deficits in CP.
颅咽管瘤（CP）和下丘脑病变（HL）患者存在认知缺陷。但哪些神经通路受到影响尚不清楚。
确定使用弥散张量成像（DTI）检测到的微观结构白质（WM）改变与儿童期起病 CP 成人的认知功能之间是否存在关系。
一项横断面研究，术后中位随访时间为 22 年（6-49 年）。
瑞典南部医疗区（250 万居民）。
纳入了 41 名（24 名女性，年龄≥17 岁）于 1958-2010 年间接受手术治疗的儿童期起病 CP 患者，以及 32 名年龄和性别分布相似的对照组。23 名患者存在 HL。
受试者进行认知测试和磁共振成像，使用 DTI 分析钩束、穹窿、扣带、海马和下丘脑以及海马体积。
右侧钩束明显改变（≤0.01）。左侧腹侧扣带的微观 WM 改变与视觉情节记忆的表现较差显著相关，解释了大约 50%的变异。背侧扣带的改变与即刻、延迟回忆和识别的表现较差相关，解释了 26-38%的变异，与视空间能力和执行功能相关，解释了 19-29%的变异。海马体积较小的患者一般知识较差（=0.028），海马微观 WM 改变与一般知识和情节视觉记忆下降有关。
提示 CP 患者扣带和海马微观 WM 改变与认知缺陷之间存在结构-功能关系。
