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Interhypothalamic adhesions: prevalence, structure, and location-based classification map in pediatric patients
Michael P Oien1, Onur Tuncer2, David Nascene3
1Mayo Clinic Department of Radiology, Mayo Building West, 2nd Floor 200 First St. SW, Rochester, MN, 55905, USA.
Insights
Interhypothalamic adhesions (IHAs) occur in 2.13% of pediatric patients and often persist over time. These adhesions show gray matter signal intensity, with Type 3 IHAs linked to pituitary abnormalities.
Area of Science:
- Pediatric Neuroradiology
- Neuroimaging
- Endocrinology
Background:
- Interhypothalamic adhesions (IHAs) are rare findings predominantly reported in pediatric populations.
- Their prevalence, persistence, and precise histological composition remain largely uncharacterized.
- Understanding IHAs is crucial for diagnosing associated neurological and endocrine conditions.
Purpose of the Study:
- To determine the prevalence of IHAs in pediatric brain MRI studies.
- To assess the persistence of IHAs through longitudinal imaging.
- To classify IHAs by anatomical distribution, explore their imaging characteristics, and identify associated pathologies.
Main Methods:
- Retrospective review of pediatric brain MRI scans (2012-2013).
- Confirmation of IHAs on at least two imaging planes.
- Measurement of IHA cross-sectional area and signal intensity (T2WIs), normalized against white and gray matter signals.
- Collection of patient demographics and clinical information.
Main Results:
- A prevalence of 2.13% (33/1550 patients) for IHAs was identified.
- IHAs demonstrated persistence in 92% of follow-up scans.
- Normalized IHA signal intensity strongly correlated with gray matter (r=0.83, P<0.001) but not white matter (r=-0.16, P=0.494).
- Commonly associated pathologies included hydrocephalus (9), prematurity (8), and corpus callosum abnormalities (7).
- All Type 3 IHAs (3/3) were associated with pituitary pathologies.
Conclusions:
- IHAs are present in 2.13% of the pediatric cohort and are largely persistent.
- IHA signal intensity on MRI mirrors that of gray matter.
- Type 3 IHAs are exclusively associated with pituitary abnormalities, highlighting their clinical significance.
Purpose:
Interhypothalamic adhesions (IHAs) have been reported only in the pediatric population, with unknown prevalence and histological composition. We aim to demonstrate their prevalence, assess their persistence through longitudinal imaging, classify IHAs by anatomical distribution, explore their structure, and report associated pathologies.
Methods:
A retrospective review was conducted on consecutive pediatric brain MRI studies obtained between January 2012, and December 2013. The presence of an IHA was only confirmed when observed on at least two planes. For each IHA, cross-sectional area was calculated, and signal intensities were measured at the center on sagittal T2WIs. Signal intensities were also measured in both cerebral white matter and gray matter for normalization and comparison. Patient demographics and clinical information were collected from electronic charts.
Results:
Out of 1550 patients (0-17.9 years), 33 (19 males, 14 females) had an IHA, resulting in a 2.13% prevalence. Follow-up images were available for 19 IHA-positive patients, and IHAs were again seen in 92% of the follow-up scans (71/77). Normalized IHA signal highly correlated with normalized gray matter signal (r = 0.83, P < 0.001), but not with normalized white matter signal (r = -0.16, p = 0.494). Common co-occurring pathologies included hydrocephalus (n = 9), prematurity (n = 8), and corpus callosum abnormalities (n = 7). All type 3 IHAs (3/3) were accompanied by pituitary pathologies.
Conclusion:
IHAs have a prevalence of 2.13% in our cohort, and the majority persist in longitudinal studies. They showed gray matter signal intensity and Type 3 IHAs exclusively accompanied pituitary abnormalities.
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