Rathke囊肿的MRI诊断分析

MRI features and clinical strategy of Rathke cleft cyst

目的探讨Rathke囊肿(RCC)临床及MRI特征,提高对其认知水平。方法选取明确诊断的61例RCC患者临床及MRI资料进行回顾性分析,并对RCC的发生机理及临床诊治进展进行文献复习,探讨相互关系。结果61例中病灶位于鞍内34例、累及鞍内鞍上24例,仅位于鞍上2例、累及鞍内鞍下(蝶窦)1例。MRI矢状位观察RCC多呈圆形、水滴状、哑铃状且位于垂体前后叶之间,冠状位观察RCC鞍内部分均居中对称。21例横径与纵径显著不成比例,19例囊内见漂浮结节。平扫病灶信号多样,增强后病灶主体均未见强化,13例见周边环形强化。手术治疗26例,随诊观察35例。结论RCC典型的MRI表现是垂体前后叶之间无强化的多变信号灶,冠状位铸状生长、囊内漂浮结节可作为本病的特征性表现,仅症状明显的RCC需手术治疗。

Objective To discuss the clinical and MRI features of Rathke cleft cysts and to improve awareness of it.Methods A retrospective analysis was conducted on the clinical and MRI data of 61 Rathke cleft cysts with a definitive diagnosis.The pathogenesis of Rathke cleft cysts and the progress of clinical diagnosis and treatment were reviewed and the relation with each other was discussed.Results Among the 61 cases,34 cysts were located intrasellarly,24 located both intrasellarly and suprasellarly,2 located only suprasellarly,and 1 was located both intrasellarly and infrasellarly(sphenoid sinus).Sagittal observation of cysts was mostly round,droplet-shaped,and dumbbell-shaped,located between the anterior and posterior lobes of the pituitary.Coronal observation of the intrasellar part of cysts was centered symmetrically.The horizontal diameter and longitudinal diameter of 21 cases were significantly disproportionate.Floating nodules were seen in 19 cases.Lesion signals were diverse.After enhancement,the main body of the lesion was not strengthened.Thirteen cases were seen peripheral ring strengthening.26 cases were subjected to surgery.35 patients were observed on follow-up.Conclusion Varied MRI signal with no enhancement,located between the anterior and posterior lobes of the pituitary are the typical MRI features of Rathke cleft cysts.Coronal cast growth and floating nodules in the sac can be characteristic of the disease.Only symptomatic RCC requires surgery.