磁共振成像对侵袭性垂体瘤的诊断价值

The Diagnostic Value of MRI For Invasive Pituitary Adenomas

目的探讨MRI在侵袭性垂体瘤诊断中的价值。方法回顾性分析125例经手术病理证实为垂体瘤(其中侵袭性垂体瘤43例,非侵袭性垂体瘤82例)患者的临床资料和MRI特征、生长方式及侵袭特点等。结果侵袭性垂体瘤中垂体大腺瘤或巨腺瘤38例,发生率较高(88.4%),明显高于小腺瘤5例(发生率11.6%)(P<0.05);生长方式以多方向生长为主31例(发生率52%),明显高于单一方向生长12例(发生率18.5%)(χ2=13.72,P<0.05);侵袭性垂体瘤中坏死和(或)囊变及出血14例(发生率32.5%)明显高于非侵袭性垂体瘤6例(发生率7.3%)(χ2=13.372,P<0.05)。侵犯方式以蔓延和包绕为主,其中海绵窦受侵21例,蝶窦内受侵22例,视交叉受累32例,第三脑室变形5例,脑实质受侵3例。MRI判断侵袭性垂体瘤的敏感性为68.2%,特异性为93.7%,阳性预测值为67%,阴性预测值为94.7%。结论 MRI可以诊断侵袭性垂体瘤及明确对邻近结构侵犯的方式和范围,从而有助于手术和治疗方案的选择。

Objective To explore the value of magnetic resonance imaging（MRI） in the diagnosis of invasive pituitary tumor. Methods 125 cases of pituitary adenomas proven by pathology, including 43 patients with invasive pituitary ade- nomas and 82 patients with non-invasive pituitary adenomas were retrospectively reviewed with their clinical and MRI mate- rials. Results Among invasive pituitary adenomas, incidences in large or huge adenomas （ 88.4% ）, multi - direction grow （52%） and hemorrhage necrosis （32.5 % ） were much more than that in small （11.6% ）, single -direction （18.5% ） and non - invasive pituitary adenomas （ 7.3 % ） respectively （ P 〈 0.05 ）. Extension style was the most type of involvement, including 21 cases with cavernous sinus invading ,22 with sphenoid sinus,32 with optic chiasm,5 with 3rd ventricle and 3 with cerebral hemisphere invading. MRI sensitivity（Sen）, specificity（Spe）, positive predictive value （PPV）, and negative predictive value（NPV） for invasive pituitary adenomas was 68.2% ,93.7% ,67% and 94.7% respectively.. Conclusion Invasive pituitary adenoma can be diagnosed by MRI ,and its extension area and manner can also be clearly demonstra- ted. Thereby contributing to choose surgery and treatment options.