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Arterial Spin Labeling and Central Precocious Puberty.

Julien Denis1,2, Volodia Dangouloff-Ros3,4,5, Graziella Pinto4,6

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Summary

Arterial spin labeling (ASL) can non-invasively assess the progression of idiopathic central precocious puberty (CPP). This method quantifies pituitary stalk perfusion, showing higher cerebral blood flow in progressive CPP cases.

Keywords:
Cerebral blood flowChildrenGnRHHypothalamic-pituitary-gonadal axisPituitary stalk

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Area of Science:

  • Pediatric Endocrinology
  • Radiology
  • Neuroimaging

Background:

  • Idiopathic central precocious puberty (CPP) is a condition characterized by early onset of puberty.
  • Accurate assessment of CPP progressivity is crucial for timely intervention.
  • Current diagnostic methods may be invasive or lack precision in determining disease trajectory.

Purpose of the Study:

  • To evaluate arterial spin labeling (ASL) as a non-invasive technique for assessing CPP progressivity.
  • To quantify pituitary stalk perfusion using ASL.
  • To compare ASL findings with the gonadotropin-releasing hormone (GnRH) test, the reference standard for defining progressive CPP.

Main Methods:

  • A retrospective study included 35 consecutive patients with early signs of puberty.
  • Patients underwent GnRH testing and cerebral MRI with ASL.
  • Perfusion values were compared between progressive and non-progressive CPP groups using the Mann-Whitney U-test.

Main Results:

  • Patients with progressive CPP exhibited significantly higher cerebral blood flow (CBF) values compared to those with non-progressive CPP (p=0.006).
  • The median CBF was 65 ml/min/100g for progressive CPP versus 45.25 ml/min/100g for non-progressive CPP.
  • A CBF threshold of 55.5 ml/min/100g demonstrated 76% sensitivity, 83% specificity, and 77% accuracy in identifying progressive CPP, with strong correlations to LH peak and LH/FSH ratio.

Conclusions:

  • Arterial spin labeling (ASL) is a promising non-invasive tool for evaluating the progressivity of idiopathic CPP.
  • ASL provides quantitative perfusion data that correlates with established hormonal markers of puberty progression.
  • This neuroimaging technique may offer a valuable alternative or adjunct to conventional diagnostic methods.