垂体腺瘤MRI特征与视觉功能损害的关系分析

Analysis of MRI characteristics and visual function in patient with pituitary adenomas

目的探讨MRI显示的垂体腺瘤大小以及视交叉高度与患者视力、视野改变之间的定量关系。方法回顾性分析136例经鼻蝶入路手术治疗的垂体腺瘤病人的临床资料，根据MRI冠状位影像测量肿瘤垂直高度（表示肿瘤大小）和视交叉中央高度，采用德国眼科协会提出视力损害评分（VIS）评估视力、视野改变。结果垂体腺瘤大小与患者视觉功能损害程度的受试者工作特征（noc）曲线显示截断点为2．15cm时，曲线面积为0．782（95％可信区间为0．664～0．900，P〈0．01），此时尤登指数取最大值，敏感度为0．824，特异度为0．647。视交叉高度与垂体腺瘤患者视觉功能损害程度的ROC曲线显示截断点为1．4mm时，曲线面积为0．675（95％可信区间为0．540-0．809，P〈0．01），尤登指数取最大值，敏感度为0．824，特异度为0．529。肿瘤大小和视交叉高度有明显的线性关系，视交叉高度（mm）=3．24—0．585×瘤大小（cm）。结论垂体腺瘤的视力、视野损害与肿瘤大小有一定相关性；术前垂体腺瘤MRI影像学特点可为患者视力视野损害评估提供依据；本研究提示肿瘤大于2．15cm或视交叉高度小于1．4mm时，会导致明显视力视野损害，建议手术，以防止患者视力视野进一步损害。

Objective To investigate the relationship of the size of the pituitary adenoma and the height of the chiasm with the visual function. Methods The clinical data of 136 patients with pituitary adenomas undergoing transsphenoidal surgery were analyzed retrospectively, including MRI and visual function data and so on. The visual field was examined by Humphrey perimetry in all the patients. The tumors vertical height serving as tumours size and chiasm central height were determined on coronal MR T1WI. The relationship of the visual function with the timorous size and the optic chiasm central vertical height was analyzed. Results The pituitary adenoma of which the vertical height was less 〈2.15 cm caused little or no visual impairment. The bitemporal visual field loss was significantly more severe in the patient with optic chiasm central height 〉1.4 mm than that in the patient with optic chiasm central height〈l.4 mm. Conclusion It is suggested that the pituitary adenoma of which the vertical height on coronal MR T,WI is more than 2.15 cin should be removed by surgery because it may cause the visual field defect.