垂体腺瘤的影像特征对诊断其侵袭性的价值

Significance of imaging signs in diagnosing the invasive pituitary adenoma

目的研究垂体腺瘤的影像特征对诊断其侵袭性的价值。方法分析103例垂体腺瘤的影像特征。以外科手术中所见为标准,分别计算各组MRI特征的敏感性(SEN)、特异性(SPE)、阳性似然比(+LR)、阴性似然比(-LR)。结果(1)出现下列征象之一者则侵袭性垂体腺瘤的诊断比较明确:肿瘤长入蝶窦腔内(+LR为∝),肿瘤包绕颈内动脉的程度≥6/8(+LR为∝),冠状片上肿瘤未超过颈内动脉海绵窦窦内、窦上段的外切线(+LR为∝);(2)排除侵袭存在的征象为:侵袭鞍底骨、鞍底形态完整(-LR为0·10),肿瘤包绕颈内动脉的程度<2/8(-LR为0),冠状片上肿瘤超过颈内动脉海绵窦窦内、窦上段的内切线(-LR为0);(3)高度怀疑侵袭存在的征象为:肿瘤跨越中分线(+LR为14·89),肿瘤包绕颈内动脉的程度在3/8和5/8之间(+LR分别为24·81、64·28、98·11)。结论上述影像征象有助于判诊断垂体腺瘤的侵袭性。

Objective To find the imaging signs for diagnosing the invasive pituitary adenoma （IPA）. Methods The radiological images obtained from 103 patients with IPA were reviewed retrospectively. The ‘ golden＇ standard diagnosing IPA was the surgical findings. The sensitivity, specificity, positive likelihood ratio （＋ LR）, and negative likelihood ratio （- LR） of imaging signs in each group were calculated. Results （1）The imaging signs for diagnosing IPA included the tumor infiltrating into the sphenoid sinus （＋LR 为∝）, the percentage encasing the internal carotid artery （ICA） of tumor being ≥6/8（d-LR 为∝ ）, the line joining the lateral wall of the intracavernous and supracavernous ICA being passed by the tumor （＋LR ∝）. （2）The imaging signs for excluding IPA were the sellar floor bone not being eroded and the morphosis of the sellar floor being integral （-LR 0. 10）, the percentage encasing the internal carotid artery （ICA） of tumor being 〈2/8 （-LR 0）, the line joining the medial wall of the intracavernous and supracavernous ICA not being passed by the tumor （-LR 0）. （3）The imaging signs for probably diagnosing IPA were the line joining the center of the intracavernous and supracavernous ICA being passed by the tumor （ ＋ LR 14.89 ）, the percentage encasing the internal carotid artery （ICA） of tumor being 〉3/8 and 〈5/8（＋LR 24. 81,98. 11, respectively）. Condusion The above-mentioned criteria may be of assistance to diagnoze IPA.