侵袭性垂体瘤的MRI和病理研究

MR Diagnosis and Pathology of Invasive Pituitary Adenoma

目的 分析侵袭性垂体瘤的MR影像学特点。材料与方法 1997年 10月～ 2 0 0 0年 5月经手术病理证实的 2 7例侵袭性垂体瘤 ,在 1.5TMR机上采用常规矢状位、冠状位增强前后T1 WI检查 ,并与手术病理资料对照分析。结果 2 7例腺瘤包括泌乳素瘤 11例 ,促生长激素腺瘤 5例 ,促生长激素和泌乳素混合腺瘤 1例 ,促甲状腺激素腺瘤 1例 ,促肾上腺皮质激素腺瘤 1例 ,无功能性腺瘤 8例。MR影像学特点为鞍底受侵下陷 ,部分肿瘤突入蝶窦 ;颈内动脉包绕 ;海绵窦受累 ,鞍隔突破等。结论 垂体腺瘤属良性肿瘤 ,但部分腺瘤的生物学行为却表现出非良性肿瘤的特征 ,如向邻近组织结构浸润生长 ,导致手术全切机率下降 ,是术后复发的主要原因。因此 ,术前正确评估肿瘤的生长特点和周围结构的关系 ,对手术方式和术后治疗措施的选择有直接指导作用。

Objective To study MRI features of the invasive pituitary adenomas.Materials and Methods Conventional sagittal and coronal T 1WI scanning both before and after Gd DTPA enhancement was performed on a 1.5T superconducting MR unit (GE) in 27 patients with pathologically proved invasive pituitary adenomas, who were encountered during Oct. 1997～May 2000 in our hospital. MRI findings were analyzed and compared with surgical and pathological results.Results Histologically, the tumor included prolactin (PRL) secreting adenoma (n=11), growth hormone (GH) secreting adenoma (n=5), mixed (GH and PRL) secreting adenoma (n=1), thyrotropic hormone (TSH) secreting adenoma (n=1), adrenocorticotropic hormone (ACTH) secreting adenoma (n=1), and nonfunctioning adenoma (n=8). MRI findings included: invasion of the sella turcica and adjacent bones, involvement of sphenoid sinus and cavernous sinus, encasement of internal carotid artery, etc.Conclusion Histologically, pituitary adenomas belong to benign tumors, but some adenomas manifest non benign biological behaviors, such as invasion to adjacent structure, resulting in radical operation failure and post operative recurrence. MRI can provide morphological features of the adenoma before surgery.