颅底型垂体瘤的临床特点及影像学表现分析

Clinical and Imaging Features of Skull Base-type Pituitary Adenoma

目的分析颅底型垂体瘤的临床特点及影像学表现。方法收集我医院2013年6月-2017年12月期间收治的118例颅底型垂体瘤患者的临床资料,均接受MRI检查,并经手术病理证实。收集和分析入选患者的人口学特征、临床症状、内分泌检查结果、术后病理结果、垂体功能减退等资料,并分析患者MRI影像学表现。结果颅底型垂体瘤患者以视力下降、头痛、头晕等为主要症状,以肢端肥大、腰背关节疼痛、月经不调等为次要症状;病理类型以泌乳素瘤、生长激素瘤居多,其次为促性腺激素瘤、促肾上腺皮质激素瘤、促甲状腺激素瘤、多激素腺瘤;多数患者为大腺瘤,伴或不伴垂体功能减退;肿瘤大小与颅底型垂体瘤病理分型密切相关(P<0.05),而与垂体功能减退情况无明显关系(P>0.05)。MRI显示颅底型垂体瘤多呈圆形或类圆形,边缘光滑清晰,为等密度或高密度肿块,部分患者可见鞍底破坏肿瘤侵入蝶窦内、因突破鞍隔生长呈"束腰征"、斑片状钙化、高密度血肿及坏死或囊变信号;T1WI低等信号,T2WI稍高或高信号动态增强扫描明显不均匀强化。结论颅底型垂体瘤在临床症状、病理类型、影像学表现等方面具有典型特征,MRI检查可清晰显示肿瘤大小、形态、出血、钙化及生长情况,对颅底型垂体瘤的术前诊断有重要作用。

Objective To analyze the clinical and imaging features of skull base-type pituitary adenoma. Methods The clinical data of 118 patients with skull base-typepituitary adenoma who were admitted to the hospital from June 2013 to December 2017 were collected. All patients were examined by MRI and confirmed by surgery and pathology. Data such as demographic characteristics, clinical symptoms, results of endocrine examination, postoperative pathological findings and hypopituitarism were collected and analyzed, and MRI findings were analyzed. Results The main symptoms of patients with skull base-type pituitary adenoma were fading eyesight, headache and dizziness. They were secondary symptoms such as acromegaly, back pain and irregular menstruation. Most of the pathological types were prolactinoma and somatotropinoma, followed by gonadotrophin adenoma, adrenocorticotropic hormone adenoma, thyroid stimulating hormone adenomaand multi-hormone adenoma. Most of the patients had large adenomas with or without hypopituitarism. The size of tumors was closely related to the pathological type of pituitary tumors（P〈0.05）, but not significantly correlated with hypopituitarism（P〈0.05）.MRI showed the skull base-type pituitary adenomas were round or oval, with clear and smooth edges, which were masses with equal density or high density. There was sellar floor tumor destruction invaded sphenoid sinus, hourglass sign because of breakthrough growth, patchy calcification, high-density hematoma and necrotic or cystic signal. T1 WI showed low and equal signal, while T2 WI showed slightly high or high signal. Dynamic enhancement scanning showed inhomogeneous enhancement. Conclusion There are typical characteristics of skull base-type pituitary adenomas in terms of clinical symptoms, pathological types and imaging findings. MRI can clearly show the size, shape, hemorrhage, calcification and growth of tumors, which is important for preoperative diagnosis of skull base-type pituitary adenoma.