1H-MRS对卵泡刺激素免疫阳性垂体腺瘤的诊断和预后评估的价值

Value of 1H-MRS to diagnosis and assessment of prognoses in patients with non-functioning gonadotroph adenomas

目的探讨1H-磁共振波谱（1H-MRS）对卵泡刺激素（FSH）免疫阳性垂体腺瘤的诊断和预后评估的价值。方法收集自2007年1月至2015年1月经病理确诊的28例FSH免疫阳性垂体腺瘤患者的临床资料,术后6例复发;Knosp分级3~4级15例,1~2级13例;所有患者术前均行1H-MRS检查,分析胆碱（Ch）/肌酐（Cr）、Ch/N-乙酰天门冬氨酸（NAA）、NAA/Cr等比值。结果28例病变区Ch/NAA比值增高比例（75.0%）较丘脑外侧皮质区明显增高（7.1%;P〈0.05）;受试者工作特征（ROC）曲线显示,Ch/NAA比值的阈值为1.2595,诊断腺瘤的敏感度为75.0%,特异度为92.9%。15例Knop分级3~4级患者Ch/NAA比值和Ch/Cr比值增高比例（80.0%）较13例Knop分级1~2级患者明显增高（15.4%;P〈0.05）;ROC曲线显示,Ch/Cr比值和Ch/NAA比值均有统计学差异（P〈0.05）,Ch/NAA比值曲线下面积为0.841,结果更为显著;Ch/NAA比值的阈值为2.235,区分腺瘤Knosp分级敏感度为80.0%,特异度为84.6%。6例复发患者Ch/Cr比值增高比例（83.3%）较22例未复发患者明显增高（27.3%;P〈0.05）;ROC曲线显示,Ch/Cr比值的阈值为2.2685,评估腺瘤复发敏感性为83.3%,特异性为72.7%。结论1H-MRS对FSH免疫阳性垂体腺瘤的术前诊断、Knosp分级和预后评估具有参考价值。

ObjectiveTo investigate the value of1H-MRS to diagnosis and assessment of prognoses in patients with non-functioning gonadotroph adenomas（NFGA）.MethodsThe clinical data of 28 patients with NFGA proved by pathological examination inwhom FSH was positive, from January, 2007 to January, 2015 were collected. The1H-MRS imaging data of 28 patients, of whom, 6 hadrelapse and 22 not, were analyzed retrospectively. The relationship of ratios of Ch/Cr, Ch/NAA and NAA/Cr with diagnosis of NFGA,Knosp grade and prognosis was analyzed.ResultsThe efficiency of1H-MRS to diagnosis of NFGA： the sensitivity, specificity, positivepredictive value, negative predictive value and accuracy rate were 75.0%, 92.9%, 91.3%, 78.8% and 83.9% respectively. The ratio of Ch/NAA threshold was 1.2595. The efficiency of1H-MRS to predicting Knosp grade： the sensitivity, specificity, positive predictive value,negative predictive value and accuracy rate were 80.0%, 84.6%, 85.7%, 78.6% and 89.3% respectively. The ratio of Ch/NAA thresholdwas 2.235. The efficiency of1H-MRS to predicting NFGA recurrence： the sensitivity, specificity, positive predictive value, negativepredictive value and accuracy rate were 83.3%, 72.7%, 45.5%, 94.1% and 75.0% respectively. The ratio of Ch/Cr threshold was 2.2685.Conclusion1H-MRS may provide valid reference index for the diagnosis, Knosp grade and prognoses in the patients with NFGA.