MRI在侵袭性垂体腺瘤术前评估中的价值及临床意义

The value of MRI and its significance in the pre-operation diagnosis of invasive pituitary adenoma

目的探讨MRI在侵袭性垂体腺瘤术前评估中的价值及临床意义。方法回顾性分析经手术病理证实的侵袭性垂体腺瘤36例,所有病例均接受3.0T MRI T1WI冠状位、矢状位,T2WI冠状位平扫及T1WI冠状位、矢状位和横轴位增强扫描。结果肿瘤以等T1、等或稍长T2信号为主,增强扫描后均匀或不均匀强化。肿瘤向周围组织侵犯表现为颈动脉包绕,海绵窦受累;鞍底下陷,部分肿瘤突入蝶窦;突破鞍隔等。MRI示海绵窦4级受侵的有24侧,3级受侵的有27侧,术中均证实海绵窦受侵犯,颈内动脉部分或完全受包绕。结论 MRI可在术前正确评估垂体腺瘤的侵袭性及侵袭范围,对手术方式以及术后治疗方案的选择具有重要的临床意义。

Objective To explore the value MRI and its significance in the pre-operation diagnosis of inva- sive pituitary adenoma. Methods 36 patients with invasive pituitary adenoma confirmed by surgery and patholo- gy were imaged with coronal and sagittal T1WI, coronal T2W1 ; post-contrast coronal , sagittal and axial T1WI, using 3.0T MRI scanner. Results The MRI appearance of the tumors was iso-intense on T1WI,iso- or high in- tense on T2WI, and homogeneously or not enhancement after Gd-DTPA injection. MRI findings included encase- ment of internal carotid artery, invasion of the sella turcica and adjacent bones, involvement of sphenoid sinus and cavernous sinus. 24 cavernous sinuses with grade-4 invasion and 27 cavernous sinuses with grade-3 invasion on MRI were confirmed involvement of cavernous sinus and encasement of internal carotid artery wholly or partly by surgery. Conclusions MRI is helpful in evaluating the invasion of pituitary adenoma before operation,which is of great clinical significance for the management of the disease.