Oct 26, 1993 - a lesion in tuber ci- nereum,. Isointense with gray matter, consistent with a hypothalamic ... hamartoma being the most ... in the tuber cinereum,.
1167
MR
Imaging
Diagnosis
Precocious Changes Pituitary
Sharafuddin1 A. Luisiri1 L. R. Garibaldi2 D. L. FuIk’1 J. B. Klein1 K. N. Gillespie3 E. R. Graviss1
M. J. A.
Puberty:
in the Shape Gland
OBJECTIVE. Central precocious stimulation and increased secretion
analyze cious
derived
MR imaging puberty
findings
compared
variables
clinical
matched
variables
with
glands
control
useful in the diagnosis
late MR imaging-derived
Importance of and Size of the
puberty occurs as a result of premature pituitary of gonadotropins. The aims of this study were to
in the pituitary
with
of Central
of children
subjects,
of central precocious the hormonal
profile
with central
to define
puberty, and other
MR
preco-
imaging-
and to cornsimaging
and
findings.
MATERIALS
AND METHODS.
Twenty-six
children
with central
precocious
puberty
(two boys and 24 girls) were divided into two subgroups according to MR imaging findings: idiopathic (21 patients) and nonidiopathic (five patients: three hypothalamic
hamartomas,
one pineal
tumor,
one empty
seila syndrome).
The control
group
con-
sisted of 17 normal age- and sex-matched children (two boys, 1 5 girls). Analyzed parameters included pituitary height, length, width, midsagittal cross-sectional area, calculated volume, and shape. The shape was assessed by a pituitary grading system and two other shape indexes (length-to-height and length-to-width ratios). Pituitary grade was defined by the concavity of the upper pituitary surface (grade 1 = marked concavity, grade 2 = mild concavity, grade 3 = fiat, grade 4 = mild convexity, grade 5 = marked convexity).
RESULTS. Pituitary grade showed a highly significant difference among groups (p .001). Area, height, and length-to-height ratio were significantly different (p < .05), whereas length, width, length-to-width ratio, and volume were not. There was no sig
1 SD below average), nor‘
mal, or elevated (>1 SD above average), adjusted normative values [22]. Peak LH
classified
as normal, early pubertal,
as compared with ageand peak estradiol’ were
or advanced
pubertal.
Multiple-regression analysis of selected MR imaging-derived variables was performed by using forced variable entry and forward stepwise variable entry methods to determine the combination most useful in correctly classifying patients into CPP and healthy groups. Variables analyzed were pituitary grade, area, height, length, width, length/height, length/width, and volume. The significance of height on area being greater than 1 SD from the corresponding mean in the control group (heights and areaa, respectively) was also studied. Finally, in the CPP group, we performed two-tailed significance ttesting
on height,
or normal)
and
area,
results
and
pituitary
grade
of pelvic
enlargement on not), respectively. also performed among selected height, length, width, insulin-like
by bone
age
sonography
Grad.
Fig. 4.-Distribution of pituitary grade by group. Grade 1 = crescent shape, grade 2 = mild concavity, grade 3 = flat, grade 4 = mild convexity, grade 5 = spherical, ICPP = Idiopathic central precocious puberty, NICPP = nonidlopathic central precocious puberty.
of the anterior pituitary relative to the pons in any of the patients. Visualization of the posterior pituitary by group was not significantly different. Differences between NICPP and control subjects were less significant, pnobably reflecting the small number of subjects in this subgroup (Table 1). Comparisons between the ICPP and NICPP subgroups showed no significant difference in any of the variables studed, namely, age, sex, Tanner stage, pelvic sonognams, bone age, insulin-like growth factor I, insulin-like growth factor I’, peak LH, peak LH’, peak estradiol, peak estradiol’, pituitary grade, height, length, width, length/height, length/width, and volume (Tables 1 and 2). in addition, when selected vanables (pituitary grade, area, height, length) in the CPP group were stratified by bone age and pelvic sonognaphic findings, patients with advanced bone age had a significantly higher pituitary grade (p < .01) and had a tendency toward greater length (p < .09), but no significant difference in height on area. Gonadal or uterine enlargement on sonography had no significant effect on the same variables. Cross-correlation analysis of pituitary gnade, area, length, height, width, insulin-like growth factor I’, peak LH’, and
(advanced
(utenine/gonadal
Cross-correlation analysis was variables (pituitary grade, area, growth factor I, peak LH, peak
estradiol).
Results Age and sex showed no significant difference among the studied groups, with the exception of age between control and NICPP groups (p < .05) (Table 1 ). This probably reflects the younger age of onset of symptoms in children with hypothalamic hamartoma [6]. Comparison of the three groups by analysis of variance yielded three parametric variables that differed significantly between ICPP and control subjects: area, height, and length/height (p < .05), whereas length, width, length/width, and volume were not significantly different. Pituitary grade showed a highly significant difference among groups (p < .001) (Fig. 4). There was no visual difference in the intensity
TABLE
1 : Ages and MR Imaging
Height
Length
(n
=
17)
1-10
(n
=
3.52
(n
=
17)
4.89
± 0.26
(n
=
(mm)
7.86 ± 0.43 (n
± 0.36
8.16
Area
(mm2)
Length/height
Length/width Volume (mm3) Note.-All =
± 0.30
=
1 7)
8.22
(n
=
± 0.82
(n
=
15)
7.60 ± 0.46 (n
=
24.6 ± 2.1
(n
=
17)
33.8
(n
=
2.61
(n
=
1 7)
1 .75 ± 0.1 1 (n
=
=
15)
1.12
± 0.07
(n
=
=
1 5)
1 54.8
± 1 4.8
(n
=
± 0.35
1.07 ± 0.12 (n 1 26.2 ± 1 8.4 (n
values except age are expressed
not significant.
[7]
as mean
±
SE. ICPP
=
± 2.7
idiopathic
Groups
NICPP
ICPP
3-10 [8]
(mm)
(yr)
Gland in ICPP, NICPP, and Control
(mm)
Width
NS
of the Pituitary
Control
Variable
Age range [median]
Characteristics
21) 21) 21) 20) 19) 21 ) 20) 20)
central
Significance
2-8 [5] 5.15 ± 1 .07 7.23 ± 0.88 9.34 ± 2.34 29.0 ± 7.9 1 .94 ± 0.83 0.95 ± 0.22 184.3 ± 61 .9
precocious
puberty,
(n
=
(n
=
(n
=
(n
=
(n
=
(n
=
(n
=
(n
=
NICPP
5) 5) 5) 5) 5) 5) 5) 5) =
Control Control NS NS Control Control NS NS nonidiopathic
(p