垂体腺瘤的三维重建及形态特性分析

Three-dimensional reconstruction and the morphological characteristics of pituitary adenomas

目的通过对垂体腺瘤进行三维影像重建,探讨肿瘤形态特征及相关因素。方法连续收集直径大于10mm的垂体腺瘤58例,其中经鼻蝶窦入路手术52例,经翼点入路手术6例;根据患者术前MRI表现,对其向蝶鞍周围扩展的程度进行分级,并运用虚拟现实技术对肿瘤进行三维模型重建及形态分类。结果所有患者均重建了肿瘤、颈内动脉及脑组织结构。垂体腺瘤三维模型分为鞍内型(13.8%)、鞍上型(20.7%)、鞍下型(17.2%)和分叶型(48.3%)。鞍内型腺瘤均为功能型,而鞍上型、鞍下型、分叶型腺瘤中,功能型分别占75%、60%和60.7%。不同形态的肿瘤,其间质地、囊变、鞍底硬脑膜是否存在侵袭,均无统计学差异。结论虚拟现实技术重建的垂体大腺瘤三维模型,能简单、直观地反映肿瘤与毗邻结构的空间关系,三维模型半数呈分叶状,腺瘤形态与其质地、囊变及侵袭性均无明显关系。

Objective Three-dimensional model of pituitary adenoma is constructed to investigate the tumor morphological characteristics and the related factors. Methods A total of 58 consecutive pituitary adenoma cases with diameter greater than 10 mm were included in the study. All the patients underwent surgery via the transnasal transsphenoidal and pterional approach,respectively. According to pre-operative MRI,tumor grade was determined by its degree of expansion around the sella. Pituitary adenomas model was reconstructed three-dimensionally by virtual reality technology,and the morphological classification was made. Results The 3D model of tumor,carotid artery and brain was reconstructed in all cases. Pituitary adenomas were categorized into intrasellar（ 13. 8%）,suprasellar（ 20. 7%）,infrasellar（ 17. 2%）,and lobulated adenomas（48. 3%）; intrasellar adenomas were all functional adenoma; while 75%,60% and60. 7% of suprasellar,infrasellar and lobulated adenomas were nonfunctioning,respectively. There was no significant statistical difference in texture,cystic degeneration and the sellar dural invasion among different groups. Conclusion 3D model reconstructed by virtual reality technology can accurately show the shape of tumors and their relationships with the adjacent structures. Half 3D models are lobulated in shape and there is no relationship between tumor morphology and texture,cystic degeneration and its invasion.