大及巨大垂体腺瘤经蝶入路切除术后MRI动态观察分析——附72例临床报告

Analysis of Serial MRI After Transsphenoidal Micro-surgery on Large and Giant Pituitary Adenomas --A Reports of 72 Cases

大及巨大垂体腺瘤经蝶人路切除术后临床上早期进行疗效评估往往存在困难,尤其是无分泌功能性垂体腺瘤。本文分析比较大和巨大垂体腺瘤经蝶手术后不同时期核磁共振(MRI)检查的影像学特点,探讨MRI对手术疗效评估的最佳时机。方法:追踪、随访直径≥2cm垂体腺瘤72例,其中PRL瘤37例,无功能性腺瘤25例,GH腺瘤2例,ACTH腺瘤2例,多分泌激素腺瘤6例。分别予术后早期(术后1～2周)、3个月、半年行MRI检查,其中45例MRI随访1年以上,进行动态观察比较。结果:72例术后早期MRI复查确定瘤影完全消失34例(47.2%);11例术后早期MRI检查报告残留,半年后复查3例消失,8例残留;27例(37.5%)术后早期MRI不能明确判定疗效,半年后复查完全切除22例,5例残留。45例术后随访1年,其MRI表现与术后半年的表现相似。结论:术后半年的MRI能较好的判断手术效果。

BACKGROUND & OBJECTIVE: It was difficult to evaluate the efficacy of transsphe-noidal microsurgery on large and giant pituitary adenomas in the early postoperative period without radiological imagin-ing, especially on nonfunctioning adenomas. We analyzed the distinguishing feature of MRI in the different postopera-tive period in order to determine the best time for evaluation of the efficacy of transsphenoidal microsurgery on large and giant pituitary adenomas. METHODS: Seventy-two pituitary adenomas with over 2 cm in diameter were followed with serial MRI scan. The tumor included 37 PRL-secreting adenomas, 25 nonfunctioning adeno-mas, 2 GH-secreting adenomas, 2 ACTH-secreting adenomas, and 6 multi- secreting adenomas. MRI scans were taken between one and two weeks, three months, and six months after operation. In addi-tion, 45 of them were followed for more than one year after surgery with MR1 scan. RE-SULTS: The early postoperative MRI scans showed that tumors were completely removed in the 34 eases (47.2%), residual tumors were seen in the 11 cases and MRI could not determine if there is residual tumor in 27 cases (37.5%). Of the 11 cases with residual tumor, the residual tumors disappeared in 3 cases six months later. Of the 27 cases with undeter-mined status on early post-operative MRI, no residual tumor was seen in 22 cases, residual tumors were in the 5 cases at 6 months. In 45 cases with more than one-year follow-up, the appearance of MRI taken at 6 months and one year after operation was similar. CONCLUSIONS: The best time for post-operative MRI scan is 6 months after surgery. It can identify residual tumor accurately. It can also be used to evaluate the efficacy of microsurgical operation, and to choose the adjuvant treatment after operation.