de Vile C J, Grant D B, Hayward R D, Kendall B E, Neville B G, Stanhope R
Medical Unit, Institute of Child Health, London.
J Clin Endocrinol Metab. 1996 Jul;81(7):2734-7. doi: 10.1210/jcem.81.7.8675604.
To quantify the extent of hypothalamic damage after surgery for craniopharyngioma using magnetic resonance imaging (MRI) and to relate the findings to changes in body mass index (BMI).
Sixty-three survivors (36 males, 27 females) of childhood cramopharyngioma were treated surgically between 1973 and early 1994.
Cranial MRI was performed at a structured follow-up assessment 1.5-19.2 yr after the initial surgery. Hypothalamic damage was scored as 0 (no visible damage), 1 (intermediate), or 2 (severe).
After surgery there was an increase in BMI standard deviation (SD) from diagnosis to study assessment in all but 7 patients. However, patients with MRI scores of 2 (n = 17) had a significantly greater increase in median BMI SD score at follow-up (+5.5 SD score), compared with +2.5 SD score and +1.1 SD score for patients with MRI scores of 1 or 0, respectively. Of the 17 cases with MRI scores of 2, 10 had a history of extreme weight loss or weight gain at presentation; preoperative neuroimaging demonstrated extensive hypothalamic infiltration by tumor in these cases.
MRI gives sufficient anatomical definition to allow assessment of the extent of hypothalamic damage and, thereby, prediction of the patients most at risk for severe post-operative weight gain.
利用磁共振成像（MRI）量化颅咽管瘤手术后下丘脑损伤的程度，并将结果与体重指数（BMI）的变化相关联。
1973年至1994年初，63例儿童颅咽管瘤幸存者（36例男性，27例女性）接受了手术治疗。
在初次手术后1.5 - 19.2年进行的结构化随访评估中进行头颅MRI检查。下丘脑损伤评分为0（无可见损伤）、1（中度）或2（重度）。
除7例患者外，所有患者术后从诊断到研究评估期间BMI标准差（SD）均增加。然而，MRI评分为2（n = 17）的患者在随访时BMI SD中位数增加显著更大（+5.5 SD评分），相比之下，MRI评分为1或0的患者分别为+2.5 SD评分和+1.1 SD评分。在17例MRI评分为2的病例中，10例在就诊时有极度体重减轻或体重增加史；术前神经影像学显示这些病例中肿瘤广泛浸润下丘脑。
MRI能提供足够的解剖学定义，以评估下丘脑损伤程度，从而预测术后体重严重增加风险最高的患者。
