垂体腺瘤200例眼部表现与MRI特点的相关性分析

Ocular presentations of pituitary adenomas and correlation with MRI features in 200 eyes

目的:分析垂体腺瘤患者200例的眼部表现,并探讨MRI特点及与眼部表现的关系。方法:回顾性分析垂体腺瘤患者200例的眼部表现,89例MRI特点及与眼部表现的相关性。结果:有眼部表现者135例(67.5%),首诊于眼科者74例(37.0%),视力下降128例(64.0%),视野缺损132例(66.0%),视乳头水肿5例(2.5%),视神经萎缩31例(15.5%),颅神经麻痹14例(7.0%),眼球突出3例(1.5%)。MRI明确诊断者84例(94.4%),肿瘤向鞍上生长者67例(75.3%),其中引起视力下降53例,视野缺损55例,视神经萎缩12例,视乳头水肿3例。向鞍旁生长者44例(49.4%),其中引起动眼神经麻痹4例,外展神经麻痹1例,三叉神经麻痹1例。向下侵入蝶窦者24例(27.0%),向后累及斜坡或压迫大脑脚者4例(4.5%),向前累及鼻咽部者3例(3.4%),累及额叶、颞叶、胼胝体、侧脑室任一者5例(5.6%)。结论:垂体腺瘤可引起视力下降、视野缺损等多种眼部表现,很多患者首诊于眼科。

AIM： To analyze the ocular presentations of pituitary adenomas of 200 patients and to investigate the relationship between magnetic resonance imaging （MRI） features and ocular presentations. METHODS： Ocular presentations of pituitary adenomas in 200 patients and Its relationship with MRI features in 89 patients were analyzed retrospectively. RESULTS： Among the 200 cases, 135 （67.5%） had ocular presentations, 74 （37.0%） visited oculists firstly, 128 （64.0%） had visual deterioration; 132 （66.0%） had visual field defect; 5 （2.5%） had optic disc edema; 31（15.5%） had optic atrophy; 14 （7.0%） had cranial nerve palsy; and 3 （1.5%） had ocular proptosis. Among the 89 cases undergoing MRI examination, 84 （94.4%） were diagnosed definitely by MRI, 67 （75.3%） showed the tumor growing upward to optic chiasm; 44 （49.4%） involved one or both sides of the sella turcica; 24 （27.0%） grew downward; 4 （4.5%） involving slope or caudex cerebri; and 3 （3.4%） grew forward. CONCLUSION： Many ocular presentations can be caused by pituitary adenomas such as visual deterioration and visual field defect. So a great number of patients with pituitary adnoma visited oculists firstly.