MRI动态增强技术对垂体微腺瘤的诊断价值

Value of dynamic contrast-enhanced MRI in the diagnosis of pituitary microadenoma

目的探究磁共振动态增强技术(DCE-MRI)在垂体微腺瘤(PMA)诊断中的价值。方法纳入巴中市中心医院及重庆医科大学附属第二医院120例疑似PMA患者,所有患者入院后行DCE-MRI检查,以临床病理检查为金标准,分析DCE-MRI对PMA的诊断价值,对比微腺瘤组织与邻近组织的DCE-MRI信号强度曲线类型、DCE-MRI参数及不同质地垂体瘤组织的DCE-MRI参数。结果经病理诊断,120例患者中PMA患者阳性83例,阴性37例。DCE-MRI诊断81例阳性,39例阴性,其中漏诊5例,误诊3例,诊断敏感度93.98%,特异度91.89%,准确率93.33%,阳性预测值96.30%,阴性预测值87.18%,Kappa值0.846,与病理诊断具有较高的一致性。PMA组织DCE-MRI信号强度以Ⅱ型、Ⅲ型为主,邻近正常组织以Ⅰ型、Ⅱ型为主,差异有统计学意义(P<0.05)。PMA组织K_(ep)、K^(trans)、Ve、MSI值显著低于邻近正常组织,TTP值显著高于邻近正常组织(P<0.05)。83例PMA中23例质硬,60例质软,质硬组K_(ep)、TTP值显著高于质软组(P<0.05),K^(trans)、Ve、MSI值显著低于质软组(P<0.05)。结论DCE-MRI扫描可有效提高PMA检出率,通过扫描获得的TIC类型、DCE-MRI参数可用于鉴别肿瘤病灶大小、范围、质地等,为临床手术提供重要参考。

Objective To investigate the application value of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)in the diagnosis of pituitary microadenoma(PMA).Methods A total of 120 patients with suspected PMA in Bazhong Central Hospital and the Second Affiliated Hospital of Chongqing Medical University were included,and all patients underwent DCE-MRI examination after admission.Clinical pathological examination was used as the gold standard to analyze the diagnostic value of DCE-MRI in PMA.The type of DCE-MRI signal intensity curve,DCE-MRI parameters and DCE-MRI parameters of different textures of pituitary tumor tissues with microadenoma tissues and adjacent tissues were compared.Results Among the 120 patients,83 cases were positive and 37 cases were negative for PMA by pathological diagnosis,and 81 cases were positive and 39 cases were negative by DCE-MRI,including 5 cases of missed diagnosis and 3 cases of misdiagnosis.The diagnostic sensitivity,specificity,accuracy rate,positive predictive value,negative predictive value and Kappa value of DCE-MRI was respective 93.98%,91.89%,93.33%,96.30%,87.18%and 0.846,and DCE-MRI was highly consistent with pathological diagnosis.The DCE-MRI signal intensity in PMA tissues was mainly typeⅡand typeⅢwhile that in neighboring tissues was typeⅠand typeⅡ(P<0.05).K_(ep),K^(trans),Ve and MSI in PMA patients were significantly lower than those in neighboring tissues while TTP was significantly higher than that in neighboring tissues(P<0.05).Among 83 cases of PMA,23 cases were tough and 60 cases were soft.K_(ep) and TTP in tough group were significantly higher than those in soft group(P<0.05),while K^(trans),Ve and MSI were significantly lower than those in soft group(P<0.05).Conclusion DCE-MRI scan can effectively improve the detection rate of PMA,and the TIC types and DCE-MRI parameters obtained by scan can be used to identify the size,scope and texture of tumor lesions and provide important reference information for clinical surgery.