T_1WI高信号Rathke囊肿与出血性垂体瘤卒中的MRI鉴别

Differentiation between Rathke cleft cyst with T_1WI high signal and hemorrhagic pituitary adenoma apoplexy by MRI

目的:分析T_1WI高信号Rathke囊肿与出血性垂体瘤卒中的MRI表现,筛选具有鉴别诊断意义的影像学特征。方法:回顾性分析经手术病理证实的40例T_1WI高信号Rathke囊肿和48例出血性垂体瘤卒中的MRI影像学资料,对比分析两组疾病的影像学特点(病灶位置、形状、冠状面对称性、体积、信号均质性、强化边界、鞍旁结构受侵、分隔征、液液平面及囊内结节)。连续变量采用t检验,分类变量采用χ~2检验,对组间差异有统计学意义的影像征象进行ROC曲线分析。结果:病灶位置、冠状面对称性、体积、信号均质性、强化边界、鞍旁结构受侵、分隔征、液液平面及囊内结节在两组疾病间的差异具有统计学意义(P<0.05);ROC分析显示病灶体积(AUC=0.886)、增强边界光滑(AUC=0.885)具有良好的诊断效能。囊内结节诊断Rathke囊肿特异度高(95.8%),鞍旁结构受侵、分隔征及液液平面征诊断垂体瘤卒中特异度高(分别为100%、100%和97.5%)。结论:病灶体积、强化边界、鞍旁结构受侵、分隔、液液平面及囊内结节等影像学特征有助于T_1WI高信号Rathke囊肿与出血性垂体瘤卒中的鉴别。

Objective:The aim of this study was to analyze the MRI features Rathke cleft cyst with T1WI high signal and hemorrhagic pituitary adenoma apoplexy and screen the imaging features with differentiating significance. Methods:The imaging data of 40 cases of T1WI high signal Rathke cleft cysts and 48 cases of hemorrhagic pituitary adenoma apoplexy confirmed by pathology were retrospectively compared and analyzed. Results:Lesion location,coronal symmetry,volume,signal homogeneity,enhanced margin,parasellar structure invasion,septation,fluid-fluid level and intracystic nodule between the two groups were significantly different ( P <0.05);ROC analysis showed that lesion volume (AUC=0.886) and enhanced margin (AUC=0.885) had good diagnostic efficacy.Intracystic nodule had high specificity (95.8%)in diagnosing Rathke cleft cyst,and the parasellar structure invasion,septation and fluid-fluid level had high specificity (100%,100% and 97.5%,respectively) in diagnosing pituitary adenoma apoplexy. Conclusion:The imaging features of lesion volume,enhanced margin,parasellar structure invasion,intracystic septation,fluid-fluid level and intracystic nodules are helpful in differentiating T1WI high signal Rathke cleft cyst from hemorrhagic pituitary adenoma apoplexy.