ESPE Abstracts (2018) 89 P-P3-292

MRI Changes in Time after Cranial Irradiation, and their Relation with Pituitary Function in Survivors of Childhood Medulloblastoma

CCN van Ommena, L van Iersela, MH Lequina, SC Clementb, GOR Janssensa, AM Bootc, HN Caronb, HL Claahsen-van der Grintend, B Granzene, KS Hana, E M Michielsf, ASP van Trotsenburgb, WP Vandertopg, DG van Vuurdeng, LCM Kremerb, AYN Schouten-van Meeterenb & HM van Santena


aUniversity Medical Center Utrecht, Utrecht, The Netherlands; bAcademic Medical Center, Amsterdam, The Netherlands; cUniversity Medical Center, Groningen, The Netherlands; dRadboud University Medical Center, Nijmegen, The Netherlands; eMaastricht University Medical Center, Maastricht, The Netherlands; fErasmus Medical Center – Sophia Children’s Hospital, Rotterdam, The Netherlands; gVrije Universiteit University Medical Center, Amsterdam, The Netherlands


Background: Hypothalamic-pituitary (HP) deficiencies are frequent in childhood brain tumor survivors (CBTS) after cranial radiation. There is currently no consensus on the most optimal way to screen for HP dysfunction regarding diagnostic tests or time interval. It is not known whether MRI changes in time in the HP-region or in brain volume are predictive of HP dysfunction.

Aim: To quantify changes in the HP-region and in brain volume on MRI in CBTS after exposure to craniospinal radiotherapy (CRT) and to study its relationship with changes in HP-function.

Methods: Eighty childhood medulloblastoma survivors selected from a previous reported nationwide cohort (1) and treated with CRT between January 2002 and December 2012, were included. All MRI scans were retrospectively systematically evaluated regarding the HP-region, at time of diagnosis, post-neurosurgical intervention, post-radiation and during follow up at 6 time points until 5 years of FU. The observers were blinded for outcome of HP function. Additional data on endocrine function and growth were collected. The pituitary gland (PG) and pituitary stalk (PS) were measured on mid-sagittal and coronal images. The coronal height and width of PG were evaluated on coronal images. PS abnormalities were assessed by measuring the ratio of the PS to basilar artery. The presence or absence of the neurohypophysis and brightness of the bright spot were reported. The mamillary bodies were measured on mid-sagittal images. Volume measurements of the total brain, hypothalamus and mamillary bodies were performed. Observations were compared with reference values for brain volume, hypothalamus and mamillary bodies and measurements of PG and PS in childhood and adolescence.

Results: Analyses are currently being performed.

Conclusion: During the ESPE meeting 2018 the results and conclusions of our study will be presented.

References: (1) Prevalence and Risk Factors of Early Endocrine Disorders in Childhood Brain Tumor Survivors: A Nationwide, Multicenter Study. Sarah C. Clement et al. (2016), Journal of Clinical Oncology, 34(36); 4362–4370.