泌乳素分泌型垂体微腺瘤多模态MRI:3D VISTA T_(2)WI与常规序列的比较

Diagnostic value of multi-modality MRI in prolactin-secreting pituitary microadenomas

目的:探讨多模态MRI对激素分泌型垂体微腺瘤的诊断价值。方法:将147例临床确诊的高泌乳素血症患者纳入研究,所有患者行垂体常规序列平扫和增强扫描(冠状面T_(1)WI、T_(2)WI和增强前后矢状面T_(1)WI)、冠状面动态增强扫描及增强后3D容积采集快速自旋回波(VISTA)序列T_(2)WI。将每例患者的MRI图像按照序列进行组合,得到3组图像集,A组包括常规序列平扫+增强扫描(动态增强扫描和常规增强扫描),B组仅包括增强后3D-VISTA T_(2)WI,C组包括所有序列的图像(A+B)。由3位放射科医师分别对3组图像进行阅片分析,采用McNemar检验比较3组中对泌乳素分泌型垂体微腺瘤的检出效能。结果:单独3D-VISTA T_(2)WI序列对垂体微腺瘤的检出结果与金标准(临床诊断结果)间的差异有统计学意义(P=0.000),平扫+增强MRI(A组)及其联合增强后3D-VISTA T_(2)WI(C组)对垂体微腺瘤的诊断结果与金标准(临床诊断结果)间的差异无统计学意义(P=0.245;P=0.109)。A组对垂体微腺瘤的诊断敏感度和特异度分别为49%(34/69)和68%(53/78),B组分别为46%(32/69)和97%(76/78),C组分别为88%(61/69)和97%(76/78);平扫+增强序列结合增强后3D-VISTA T_(2)WI的综合影像组(C组)显示出更高的敏感度和特异度。结论:对于高泌乳素血症患者,增强后3D-VISTA序列T_(2)WI作为常规MRI序列的重要补充,可明显提高诊断的敏感性及阴性预测值,该序列联合平扫+增强序列在诊断泌乳素型垂体微腺瘤方面具有重要价值。

Objective:This aim of this study was to investigate the diagnostic value of multi-modality MRI in prolactin-secreting pituitary microadenomas.Methods:147 patients with clearly clinical diagnosis of hyperprolactinaemia were enrolled in this study.Pre-contrast coronal T_(1)WI,T_(2)WI and sagittal T_(1)WI were performed.After administration of contrast medium,coronal dynamic contrast enhanced(DCE)-T_(1)WI and 3D volume isotropic turbo spin echo acquisition(VISTA)sequence T_(2)WI were performed.The detection of pituitary micro-lesion of group A(plain and DCE-MRI),group B(post-contrast 3D-VISTA T_(2)WI alone)and group C(including all sequences of plain and DCE-MRI+3D-VISTA T_(2)WI)were compared.The McNemar's test was used to analyze the detection ability of the three groups on pituitary microadenomas.Results:There was significant difference(χ^(2)=29.641,P=0.000)in the diagnostic result between group B and golden criteria clinical diagnostic result,but there was no significant difference(χ^(2)=1.350,P=0.245;P=0.109)in the diagnostic result between group A and group C with golden criteria.The diagnostic sensitivity and specialtivity for pituitary microadenomas ingroup A were 49%(34/69)and 68%(53/78),respectively;those were 46%(32/69)and 97%(76/78)in group B,and 88%(61/69)and 97%(76/78)in group C;combination of plain+DCE-MRI and post-contrast 3D-VISTA T_(2)WI showed the highest detection efficacy for pituitary microadenomas.Conclusion:For patients with hyperprolactinemia,post-contrast 3D-VISTA T_(2)WI sequence is an important supplement to DEC-MRI for high sensitivity and negative predictive value,the combination of the two sequences play an important role in detecting prolactin-secreting pituitary microadenomas.