无功能垂体大腺瘤经蝶窦入路手术后核磁共振随访

MRI follow-up after transsphenoidal surgery in patients with nonfunctional pituitary macroadenoma

目的 探讨无功能垂体大腺瘤经蝶窦入路手术后MRI随访的最佳时间。 方法 回顾性分析 5 0例术前、术后 1周内 (早期 )、术后 3个月 (中期 )、术后 1年 (后期 )的MRI资料。观察术后不同时期MRIT1增强前后鞍内容物的变化及判断肿瘤切除的程度。 结果 术后早期MRI显示鞍区内容物高度减小 8%～ 32 % ,肿瘤消失 2 2例 ,怀疑残余肿瘤 2 8例。术后 3个月MRI显示鞍区内容物体积减少 11%～ 85 % ,MRI冠状位上鞍区内容物体积减少 5 0 %以上 11例 ,减少 30 %～ 5 0 % 9例 ,<30 % 8例 ;术后早期怀疑残余肿瘤 2 8例中 ,2 3例确定鞍区存在残余肿瘤。术后 1年MRI显示鞍区内容物无变化 4 6例 ,继续减少 4例。

Objective To study the optimal time of MRI follow-up after transsphenoidal surgery in patients with nonfunctional pituitary macroadenoma. Methods MRI records of 50 patients before surgery,within 1 postoperative week (early stage),at 3 months (intermediate stage) and 1 year after surgery (late stage),respectively,were retrospectively analyzed.Dynamic changes in the sella turcica were observed and the degrees of tumor excision were studied before and after MRI T 1-weighted enhanced scans at different postoperative stages. Results In the early stage MRI images showed that the size of sellar contents decreased by 8%～32%,tumor disappeared in 22 cases,and suspected residual tumor was found in 28 cases.At 3 months after surgery,MRI scans revealed that sellar contents decreased by 11%～85% in size.On coronal position MRI scans,the size of sellar contents decreased more than 50% in 11 cases,30%～50% in 9 cases,less than 30% in 8 cases.Out of the 28 cases that were suspected of residual tumor in the early stage,confirmation of residual tumor in the sella turcica was made in 23 cases.MRI findings 1 year after surgery showed no change in the sella turcica in 46 cases and continuing to decrease in 4 cases. Conclusions Re-examination of MRI in intermediate stage after transsphenoidal surgery in patients with nonfunctional pituitary macroadenoma facilitates the detection of residual tumor and recurrence.