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Purpose <p>To identify radiological features distinguishing adamantinomatous craniopharyngioma (ACP) from papillary craniopharyngioma (PCP) and assess their impact on pituitary-hypothalamic-axis dysfunction and post-surgery recurrence.</p> Methods <p>MRIs of 80 patients (48 with ACP, 32 with PCP) were analyzed for tumor topography, size, cystic-solid composition, peritumoral edema, signal intensity, and CT for calcification patterns. Volumes, normalized signal intensity minimum (nT2<sub>min</sub>) and maximum (nT1<sub>Max</sub>) values were measured from T2 and T1-weighted images, respectively. <?tk 1?>These variables were correlated with pituitary-hypothalamic-axis dysfunction and surgical outcomes.</p> Results <p>There were no significant topographic differences between ACP and PCP (<i>P</i> &gt; 0.85). ACP tumors had larger volumes (4992.2 ± 5195.5&#xa0;mm³ vs. 814.4 ± 1023&#xa0;mm³), a predominant cystic component, lower nT2<sub>min</sub> values (42.57% vs. 55.55%), higher nT1<sub>Max</sub> values (273.25% vs. 216.67%), and more peripheral calcifications (<i>P</i> &lt; 0.001). <?tk 1?>In ACP lower nT2<sub>min</sub> and higher nT1<sub>Max</sub> values correlated with incomplete surgical excision (nT2<sub>min</sub>: <i>P</i> &lt; 0.001, <i>r</i> = -0.607; nT1<sub>Max</sub>: <i>P</i> &lt; 0.001, <i>r</i> = 0.817) while only lower nT2<sub>min</sub> values correlated with higher recurrence likelihood (nT2<sub>min</sub>: <i>P</i> &lt; 0.001, <i>r</i> = -0.485). Regardless of histotype, tumors invading the third ventricle floor were more likely to show peritumoral edema (<i>P</i> &lt; 0.001), hypothalamic infiltration (<i>P</i> &lt; 0.001), and dysfunction (<i>P</i> = 0.013).</p> Conclusion <p>Tumor location relative to the third ventricle and associated parenchymal changes are independent predictors of hypothalamic dysfunction, regardless of tumor histotype. <?tk 1?>ACP’s cystic composition characterized by a higher concentration of thick or proteinaceous material and peripheral calcifications predict poorer surgical outcomes.</p>

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Tumor features in adult papillary and adamantinomatous craniopharyngioma: neuroradiological evaluation of pituitary-hypothalamic-axis dysfunction and outcome prediction

  • 期刊论文

  • 发表日期：

    2025年4月28日

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  • Rosalinda Calandrelli,
  • Fabio Pilato,
  • Gabriella D’Apolito,
  • Alessandro Grimaldi,
  • Sabrina Chiloiro,
  • Marco Gessi,
  • Antonella Giampietro,
  • Antonio Bianchi,
  • Federico Valeri,
  • Francesco Doglietto,
  • Liverana Lauretti,
  • Simona Gaudino

摘要

Purpose

To identify radiological features distinguishing adamantinomatous craniopharyngioma (ACP) from papillary craniopharyngioma (PCP) and assess their impact on pituitary-hypothalamic-axis dysfunction and post-surgery recurrence.

Methods

MRIs of 80 patients (48 with ACP, 32 with PCP) were analyzed for tumor topography, size, cystic-solid composition, peritumoral edema, signal intensity, and CT for calcification patterns. Volumes, normalized signal intensity minimum (nT2min) and maximum (nT1Max) values were measured from T2 and T1-weighted images, respectively. These variables were correlated with pituitary-hypothalamic-axis dysfunction and surgical outcomes.

Results

There were no significant topographic differences between ACP and PCP (P > 0.85). ACP tumors had larger volumes (4992.2 ± 5195.5 mm³ vs. 814.4 ± 1023 mm³), a predominant cystic component, lower nT2min values (42.57% vs. 55.55%), higher nT1Max values (273.25% vs. 216.67%), and more peripheral calcifications (P < 0.001). In ACP lower nT2min and higher nT1Max values correlated with incomplete surgical excision (nT2min: P < 0.001, r = -0.607; nT1Max: P < 0.001, r = 0.817) while only lower nT2min values correlated with higher recurrence likelihood (nT2min: P < 0.001, r = -0.485). Regardless of histotype, tumors invading the third ventricle floor were more likely to show peritumoral edema (P < 0.001), hypothalamic infiltration (P < 0.001), and dysfunction (P = 0.013).

Conclusion

Tumor location relative to the third ventricle and associated parenchymal changes are independent predictors of hypothalamic dysfunction, regardless of tumor histotype. ACP’s cystic composition characterized by a higher concentration of thick or proteinaceous material and peripheral calcifications predict poorer surgical outcomes.