Reversibility of cerebral ventricular enlargement in anorexia nervosa, demonstrated by quantitative magnetic resonance imaging

Objective: To determine the reversibility of the loss of brain parenchyma and ventricular enlargement in patients with anorexia nervosa after refeeding. Study design: Quantitative magnetic resonance imaging was performed on three groups of subjects: (1) 12 female adolescents hospitalized with anorexia nervosa, (2) the same 12 patients after nutritional rehabilitation, a mean of 11.1 months later, and (3) 12 healthy age-matched control subjects. Sixty-four contiguous coronal magnetic resonance images, 3.1 mm thick, were obtained. With a computerized morphometry system, lateral and third ventricular volumes were measured by a single observer unaware of the status of the patient. Results: On admission, patients were malnourished and had lost an average of 11.7 kg (body mass index, 14.3 ± 2.0 kg/m²). After refeeding, they gained an average of 9.7 kg (body mass index, 17.9 ± 1.5 kg/m²). Total ventricular volume decreased from 17.1 ± 5.5 cm³ on admission to 12.4 ± 3.0 cm³ after refeeding (p <0.01) and returned to the normal range. The degree of enlargement of the third ventricle was greater than that of the lateral ventricles. There was a significant inverse relationship between body mass index and total ventricular volume (r = - 0.63; p <0.05). Conclusion: In patients with anorexia nervosa, cerebral ventricular enlargement correlates with the degree of malnutrition and is reversible with weight gain during long-term follow-up.