淋巴细胞性垂体炎的MRI诊断

MRI Diagnosis of Lymphocytic Hypophysitis

目的分析淋巴细胞性垂体炎(LyH)的MRI表现,探讨MRI在LyH影像诊断中的价值。资料与方法回顾性分析经手术病理证实(3例)和临床证实(9例)的12例LyH患者的临床及影像学资料,探讨其典型MRI表现。结果 12例患者中,11例临床症状表现为多饮、多尿,9例为持续性头痛,6例视力下降或(和)视野缺损,3例全身乏力或(和)性欲下降及毛发减少,1例表现为持续性溢乳、闭经,1例合并白塞病,1例合并干燥综合征。12例患者MRI均表现为垂体体积不同程度增大,4例伴有垂体柄增粗,4例合并视交叉受压上抬改变,1例伴有双侧泪腺增大强化及邻近前颅窝脑膜明显增厚、强化。经激素治疗1～3周后复查,9例患者垂体体积均有缩小,其中4例垂体柄变细,4例受压上抬的视交叉恢复原位。结论 LyH患者典型的MRI表现为垂体增大、较均匀强化,垂体柄增粗但无明显倾斜。

Purpose To analyze the MRI findings of lymphocytic hypophysitis (LyH) and explore the value of MRI in LyH imaging diagnosis. Materials and Methods Clinical and imaging data of 12 patients with LyH confirmed by surgical pathology (3 cases) and clinical practice (9 cases) were retrospectively analyzed. Typical MRI findings were explored. Results For 12 patients, 11 had clinical symptoms of polydipsia and polyuria, 9 persistent headache, 6 diminution of visual acuity or/and visual field defects, 3 generalized weakness or/and decreased sexual desire and hair, 1 persistent galactorrhea and amenorrhea, 1 combined Behcet's disease and 1 combined Sjogren's syndrome. The MRI findings of 12 patients showed varying degrees of enlargement of pituitary volume, with 4 cases c oupled with thickening of pituitary stalk, 4 cases combined with optic chiasma uplift and change by pressure, and 1 case with bilateral lacrimal enlargement and obvious thickening and strengthening of adjacent anterior cranial fossa meninges. Reexamination 1-3 weeks after hormonal therapy found that the pituitary volume of 9 patients was reduced. Among them, 4 cases of pituitary stalk became thinner, and 4 cases of optic chiasma uplifted by pressure were restored to situ. Conclusion The typical MRI findings of patients with lymphocytic hypophysitis are pituitary enlargement, homogeneous enhancement, and thickened pituitary stalk with no obvious inclination.