title: Semiquantitative analysis of hypothalamic damage on MRI predicts risk for hypothalamic obesity.
abstract: OBJECTIVE
  Excessive weight gain frequently occurs in patients with hypothalamic tumors and lesions leading to hypothalamic obesity (HO).
  
  
  METHODS
  Digital brain magnetic resonance imaging (MRI) and clinical outcomes were studied retrospectively in a single center, including 45 children with postoperative lesions in the sellar region (41 craniopharyngiomas, 4 with Rathke's cleft cysts), ∼5 years post-surgery, mean age 13.9 years. Four standard sections covering hypothalamic areas critical to energy homeostasis were used to assess lesions and calculate a hypothalamic lesion score (HLS); the association with HO was examined.
  
  
  RESULTS
  Compared to subjects who did not develop HO (n = 23), subjects with HO (n = 22) showed more frequently lesions affecting the third ventricular floor, mammillary bodies, and anterior, medial (all P < 0.05), and most importantly posterior hypothalamus (P < 0.01). The HLS correlated significantly with BMI z-score changes 12 and 30 months post-surgery, even after adjusting for potential confounders of gender, age at surgery, surgery date, surgery BMI z-score, hydrocephalus, and residual hypothalamic tumor (r = 0.34, P = 0.03; r = 0.40, P = 0.02, respectively). Diabetes insipidus was found to be an endocrine marker for HO risk.
  
  
  CONCLUSIONS
  The extent of damage following surgery in the sellar region can be assessed by MRI using a novel scoring system for early HO risk assessment.
authors.affiliation: Center for Integrative Brain Research, Seattle Children's Hospital & Research Institute, Seattle, Washington, USA.|Pediatric Endocrinology, Seattle Children's Hospital & Research Institute, Seattle, Washington, USA.
authors.forename: Christian L
authors.initials: CL
authors.lastname: Roth
authors.affiliation: Neuroradiology, Seattle Children's Hospital & Research Institute, Seattle, Washington, USA.
authors.forename: Hedieh
authors.initials: H
authors.lastname: Eslamy
authors.affiliation: Pediatric Endocrinology, Seattle Children's Hospital & Research Institute, Seattle, Washington, USA.
authors.forename: David
authors.initials: D
authors.lastname: Werny
authors.affiliation: Center for Integrative Brain Research, Seattle Children's Hospital & Research Institute, Seattle, Washington, USA.
authors.forename: Clinton
authors.initials: C
authors.lastname: Elfers
authors.affiliation: Center for Clinical and Translational Research, Seattle Children's Hospital & Research Institute, Seattle, Washington, USA.
authors.forename: Michele L
authors.initials: ML
authors.lastname: Shaffer
authors.affiliation: Pediatric Endocrinology, Seattle Children's Hospital & Research Institute, Seattle, Washington, USA.
authors.forename: Catherine
authors.initials: C
authors.lastname: Pihoker
authors.affiliation: Neurosurgery, Seattle Children's Hospital & Research Institute, Seattle, Washington, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Ojemann
authors.affiliation: Center for Integrative Brain Research, Seattle Children's Hospital & Research Institute, Seattle, Washington, USA.
authors.forename: William B
authors.initials: WB
authors.lastname: Dobyns
mesh_terms: D000293:Adolescent; D015992:Body Mass Index; D002648:Child; D003397:Craniopharyngioma / Q000150:complications* / Q000601:surgery; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000473:pathology; D007027:Hypothalamic Diseases / Q000209:etiology* / Q000473:pathology*; D007031:Hypothalamus / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D063766:Pediatric Obesity / Q000209:etiology*; D010911:Pituitary Neoplasms / Q000150:complications* / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment; D015430:Weight Gain