侵袭性垂体腺瘤磁共振成像与谷胱甘肽转移酶P1的相关性

目的研究侵袭性垂体腺瘤(PA)的磁共振成像(MRI)与谷胱甘肽转移酶(GST)P1的相关性。方法接受磁共振成像(MRI)诊断及手术治疗的PA患者106例,分析手术结果及垂体腺瘤的GSTP1表达情况,PA鞍底扩展与GSTP1表达情况,PA鞍旁扩展与GSTP1表达情况及颈内动脉的包绕程度和侵袭性联系。结果侵袭性PA的GSTP1表达显著高于非侵袭性PA(P0.05)。Spearman法分析PA向下扩展程度和侵袭性呈正相关(r=0.764,P=0.000)。累及鞍底的PA GSTP1表达水平较未累及鞍底者更高。肿瘤和颈内动脉连线关系对PA侵袭性判定有统计学意义(χ2=121.54,P=0.000)。侵袭性与非侵袭性PA颈内动脉包绕程度的差异有统计学意义(χ2=133.89,P=0.000)。累及海绵窦的GSTP1表达水平显著高于未累及海绵窦者(χ2=5.382,P=0.000)。结论侵袭性PA MRI与GSTP1之间具有较好的正相关联系,临床诊断可结合二者的征象及表达情况进行综合判定,最终获得最佳效果。     

老年侵袭性垂体瘤分子水平研究进展

老年侵袭性垂体瘤为良性肿瘤,却呈现恶性生物学行为,可以侵袭周围的硬膜、骨质或侵入海绵窦、蝶窦等结构,瘤体侵入海绵窦内并超过颈内动脉床突上段和海绵窦段中线连线水平被认为是侵袭性诊断的较为明确的指标。侵袭性垂体腺瘤具有高增殖、高侵袭、易复发、临床治愈率低、预后不佳的特点。     

海绵窦海绵状血管瘤及其影像学特点

目的阐述海绵窦海绵状血管瘤的MRI表现。方法回顾性分析5例经手术及病理学证实并行MRI检查的海绵窦海绵状血管瘤病例。结果5例海绵窦海绵状血管瘤呈外大内小哑铃状改变,在T1加权成像上信号较低,T2加权成像上呈明显高信号,甚至高过脑脊液,增强后病变明显均匀强化。病变侧颈内动脉向前向下推移,并形成假包绕征象。结论如果中年女性海绵窦内肿瘤表现为MRIT2加权成像信号等于或高于脑脊液,颈内动脉向前向下移位,应首先考虑海绵窦海绵状血管瘤。     

海绵窦海绵状血管瘤及其影像学特点

目的：阐述海绵窦海绵状血管瘤的MRI表现。方法：回顾性分析5例经手术及病理学证实并行MRI检查的海绵窦海绵状血管瘤病例。结果：5例海绵窦海绵状血管瘤呈外大内小哑铃状改变，在T1加权成像上信号较低，T2加权成像上呈明显高信号，甚至高过脑脊液，增强后病变明显均匀强化。病变侧颈内动脉向前向下推移，并形成假包绕征象。结论：如果中年女性海绵窦内肿瘤表现为MRI T2加权成像信号等于或高于脑脊液，颈内动脉向前向下移位，应首先考虑海绵窦海绵状血管瘤。     

海绵窦海绵状血管瘤的MRI影像表现

目的探讨海绵窦海绵状血管瘤的影像表现,分析磁共振成像(MRI)在海绵窦海绵状血管瘤中的诊断价值。方法回顾性分析2009-01~2017-01该院收治的12例经手术证实海绵窦海绵状血管瘤的MRI表现。结果 12例患者TIWI呈等及略低信号,T2WI呈高信号,增强扫描全部呈明显强化,病灶呈哑铃状,边界清晰,颈内动脉受包绕,邻近脑组织受压,未出现水肿信号。结论 MRI在诊断海绵窦海绵状血管瘤中具有重要的应用价值。     

伽玛刀治疗生长激素腺瘤的疗效

<正>生长激素(GH)型垂体腺瘤是缓慢进展的疾病,临床主要表现为巨人症和肢端肥大症,且具有侵袭性生长的倾向,特别是对视交叉,视丘下部及海绵窦的侵犯,单独手术很难治愈,其手术治疗肿瘤复发率达20%~50%〔1〕。放射治疗是垂体瘤治疗的重要手段之一,包括常规放射和立体定向放射。对于控制肿瘤生长、减少肿瘤复发、改善内分泌功能有积极作用。1资料与方法1.1一般资料35例GH型垂体腺瘤,年龄48~67岁,平均     

经纵裂胼胝前切除巨大垂体腺瘤的显微应用解剖学研究

对 17个用甲醛固定、红色明胶动脉灌注的尸头标本采用显微解剖技术 ,观察其蝶鞍区的有关神经和血管。结果 :1视交叉前间隙的面积为 2 8.38± 6 .2 2 mm2 ,视交叉前缘至鞍结节的距离为 4.12± 0 .78mm。 2前穿动脉主要来源于大脑前动脉交通前段和颈内动脉终末段 ,穿入前穿质前可分为多支或形成动脉丛。3两侧颈内动脉海绵窦段水平部之间的距离为 16 .48± 4.35 mm,在穿经海绵窦上壁处间距为 13.2 5± 2 .48mm,在大脑前动脉发起处间距为 17.86± 1.5 5 mm。 4前交通动脉在视交叉之上者占 82 .35 % ,之前者占 14.2 9% ,侧方者占 5 .89%。5动眼神经在后床突的前外侧 7.82± 2 .12 mm处穿海绵窦顶入海绵窦 ,入窦点在颈内动脉床突上段后方 4.96±2 .0 2 mm,两侧入窦点之间的距离为 2 1.93± 2 .31mm。认为经纵裂胼胝体前入路垂体瘤切除术主要通过视交叉前间隙 ,在颈内动脉之间操作 ,手术中既要保护颈内动脉、视神经、动眼神经等较大结构 ,又要尽量避免穿动脉、下丘脑支动脉等小动脉的损伤 ,以减少并发症的发生。     

CT与MRI诊断鼻咽癌的对比研究

目的 探讨鼻咽癌向周围邻近结构侵犯的CT和MRI表现。并比较其诊断价值。方法 分析经病理证实的2l例NPC患者CT和MRI资料。结果 鼻咽癌瘤体T1WI等信号14例(66,7％),T2WI高信号18例(85．7％),增强T1WI高信号9例(100％)。CT、MRI显示鼻咽癌以下结构的浸润率有显著性差异：完全茎突后间隙、颅骨和海绵窦(P值分别为0．015,0.000和0．017)。副鼻窦检出率分别为14．3％和4．8％,但P值为0．143。其余结构两者检出无统计学差异。结论 以MRI为鼻咽癌患者首选影像学检查,可更准确了解肿瘤侵犯范围。     

垂体大腺瘤与鞍隔脑膜瘤的CT、MRI鉴别诊断

目的提高CT、MRI对垂体大腺瘤与鞍隔脑膜瘤的鉴别诊断能力,有助于临床采取正确的肿瘤手术入路,可成功切除肿瘤。方法对340例垂体大腺瘤与18例鞍隔脑膜瘤的CT、MRI表现与手术病理进行对照分析。结果垂体大腺瘤组肿瘤由鞍内向鞍上、第三脑室、鞍旁海绵窦、蝶骨嵴、斜坡、额部等侵袭生长。鞍隔脑膜瘤组肿瘤位于鞍隔之上伴鞍内14例,鞍上伴第三脑室、鞍旁4例。结论二者的主要鉴别点CT、MRI显示垂体大腺瘤由垂体窝向鞍上、鞍旁海绵窦侵袭性生长时受鞍隔孔的阻力,呈“花生”状、“哑铃”状、“腰鼓”状,肿瘤中心位于鞍内,垂体窝扩大,无正常垂体腺结构。CT、MRI显示鞍隔脑膜瘤由鞍隔向鞍上生长,亦向鞍内生长,肿瘤中心位于鞍上,鞍隔之上的肿瘤,肿瘤压迫使垂体腺变扁。     

神经导航系统引导单鼻孔蝶窦入路垂体瘤切除术的应用

目的观察神经导航系统引导单鼻孔蝶窦入路垂体瘤切除术的应用效果。方法32例垂体瘤患者,术前行MRI或CT薄层扫描,将图像资料输入Brain LAB Vector Vision神经导航系统中进行三维重建,据此设计最佳手术入路,并对肿瘤及重要结构作标记;术中在神经导航系统的引导下寻找蝶窦前壁、鞍底、颈内动脉、海绵窦和斜坡等结构,切除肿瘤。结果32例均在神经导航引导下经鼻蝶入路顺利到达肿瘤部位,注册误差0．3～2．5mm;肿瘤全切除24例,次全切除6例,大部切除2例;术后26例症状有不同程度的改善,6例无变化,无严重并发症出现。结论神经导航引导单鼻孔蝶窦入路垂体瘤切除术定位准确、肿瘤全切除率高、并发症少。     

MRI diagnosis of cavernous sinus invasion by pituitary adenomas

Several MRI signs are helpful for the preoperative MRI diagnosis of cavernous sinus invasion by an adenoma. The first step is to analyse the percentage of encasement of the intracavernous ICA by the adenoma. If this percentage is greater than or equal to 66%, the cavernous sinus is invaded. If the percentage of encasement of intracavernous CA is less than 25%, the cavernous sinus is not invaded. If the percentage of encasement is between 25 and 66%, the analysis of the cavernous venous compartment, the drawing of intercarotid lines and the analysis of the shape and venous compartments of the cavernous sinus are necessary. The cavernous sinus invasion remains very likely if the carotid sulcus venous compartment is obliterated, or if the lateral intercarotid line is crossed. Conversely, if the median intercarotid line is uncrossed, the superior venous compartment is visible, the cavernous sinus is of normal size, or there is no bulging of its lateral dural wall, invasion of the cavernous sinus space can reliably be excluded.     

Tumors invading the cavernous sinus that cause internal carotid artery compression are rarely pituitary adenomas

There is a clinical impression that when tumors invade the cavernous sinus, compression of the internal carotid artery is rare with pituitary adenomas and more common with other types of lesions but there are no actual data to support this impression. To confirm the impression that the finding of internal carotid artery compression by tumors invading the cavernous sinus is inconsistent with a diagnosis of a pituitary adenoma, we performed a retrospective analysis of MRI scans performed between 2000 and July 2009. An initial search of the radiology database was performed using the terms ??invasive mass cavernous MRI?? and subsequent refinement narrowed the evaluation to 141 patients with cavernous sinus invasion by sellar/parasellar tumors for whom there were clinical/pathological data to determine tumor type. 83 of the 141 patients with cavernous sinus invasion had carotid artery encasement; 58 were pituitary adenomas and 25 were other types of lesions. Eight of these 83 scans revealed compression of the internal carotid lumen, with only one being a pituitary adenoma and seven being other types of lesions. Therefore, only 1/58 (1.7%) of pituitary adenomas and 7/25 (28%) of non-pituitary adenoma lesions that encased the internal carotid artery caused compression of the artery (P?=?0.0007). A mass lesion that invades the cavernous sinus and encases the internal carotid artery is very unlikely, therefore, to be a pituitary adenoma if it compresses the lumen of the internal carotid artery.     

Neuroimaging of aggressive pituitary tumors

Aggresssive pituitary tumors are defined as radiologically invasive, exhibiting a rapid growth and a poor response to the medical and surgical treatment options. The role of magnetic resonance imaging (MRI) is fundamental to assess tumor aggressiveness before surgical exploration. Distinction between cavernous sinus invasion and cavernous sinus compression is often challenging and cannot be solved always by using the Knosp criteria. Ideally, T2W images demonstrating the ruptured internal dural wall of cavernous sinus is the ultimate proof of cavernous sinus invasion. Subtle tumor volume increase in a short time can be shown when sequential MR images are rigorously replicable. A microcystic pattern observed on T2W images frequently reflects a potentially aggressive tumor as observed in silent corticotroph pituitary adenomas.

     

Successful treatment of Cushing��s disease caused by ectopic intracavernous microadenoma

Adrenocorticotropic hormone (ACTH)-secreting pituitary adenomas are sometimes difficult to visualize, even with high-quality magnetic resonance imaging, due to their small size and variable location. Sampling the cavernous or inferior petrosal sinus is helpful for confirming the central origin of a tumor, but ectopic corticotroph adenomas in the paraseller region also typically exhibit a high central/peripheral plasma ACTH ratio. We experienced an extremely rare case of Cushing??s disease caused by an ACTH-secreting microadenoma located entirely inside the left cavernous sinus attached to the medial wall (ectopic pituitary adenoma) that was not visible by preoperative MRI. In this case, the microadenoma was completely removed and an endocrinologic cure was achieved. This case reveals that in addition to meticulous sectioning of the pituitary gland, bilateral periglandular inspection with visualization of the medial wall of the cavernous sinus and of the diaphragm should always be performed to detect ectopic parasellar microadenomas when no adenoma is visible by preoperative MRI.     

Influence of parasellar extension of macroprolactinomas defined by magnetic resonance imaging on their responsiveness to dopamine agonist therapy

OBJECTIVE AND DESIGN: The resistance of macroprolactinomas to dopamine agonist (DA) therapy, whether defined as an absence of PRL normalization or the lack of significant tumour shrinkage after prolonged treatment at high doses, is usually regarded as unpredictable. The aim of this retrospective study, conducted in a teaching hospital, was to determine whether cavernous sinus (CS) invasion assessed by magnetic resonance imaging (MRI) is associated with a higher rate of resistance to DA therapy. METHODS: Forty-nine patients with a macroprolactinoma were included in this study and classified into four groups according to the percentage of encasement of the intracavernous internal carotid artery (ICA) by the tumour. All patients received DA as the primary treatment, mainly cabergoline (CAB). PRL normalization and tumour shrinkage during treatment were evaluated as a function of CS invasion. RESULTS: Tumours encasing more than three-quarters of the intracavernous ICA (group 4) were less responsive to DA therapy, exhibiting a lower rate of early (< or = 3 months) PRL normalization (8%vs. 69% in the others groups; P < 0.01) under a higher dose of CAB (median: 3.5 mg vs. 1.0 mg per week; P < 0.01). CS invasion was a strongly significant and independent predictor of hormonal resistance to CAB (P < 0.01). This hormonal resistance occurred in eight patients (16%), all but one belonging to group 4. Significant tumour shrinkage was observed in 31 out of 45 assessable cases (69%) and was more likely to occur in the case of PRL normalization (P < 0.01). CONCLUSIONS: Parasellar extension of macroprolactinomas, assessed on the basis of strict MRI criteria, may predict a negative response to DA. The responsiveness of noninvasive macroprolactinomas (over 90%) is similar to that reported in microprolactinomas, whereas invasive tumours are resistant to treatment in more than 50% of cases.     

Imaging of invasiveness of pituitary adenomas

The purpose of our study was to examine the tumor size, imaging invasiveness of the pituitary macroadenomas (PMA) and to evaluate the directions of PMA spread. One hundred and thirty-five patients with PMA were examined with MRI and/or CT for pre-operative evaluation. We retrospectively reviewed the CT and MRI to identify tumor size, extension and to evaluate the directions of tumor spread. One hundred and seventeen patients (87%) had suprasellar extension with compression of optic apparatuses, twelve patients (9%) had extension of tumor upward to hypothalamus and third ventricle. Infrasellar extension via the floor of the sella and sphenoid sinus was found in thirty-eight patients (28%), and further downward extension to ethmoid sinus, nasopharynx and/or skull base was depicted in five patients (4%). Twenty-two patients (16%) had lateral invasion to the cavernous sinus and associated cranial nerves. Temporal and frontal extensions were depicted in seven patients (5%) and six patients (4%), respectively. Five patients (4%) had posterior subtentorial extension to posterior fossa. Histologically, only two patients showed microscopic invasive features. There was no correlation between histologic features and imaging invasiveness. The PMA had the potential of multi-directional extension. This experience indicated any type of pituitary adenoma could invade surrounding structures. Suprasellar invasion was the most common direction of pituitary adenoma spread, followed by infrasellar, lateral, anterior and posterior routes.     

Primary pituitary lymphoma in immunocompetent patient: diagnostic problems and prolonged follow-up

Primary pituitary lymphoma in immunocompetent patients is a rare disease and has been described in less than 20 cases. Moreover, low-grade lymphomas constitute only 3% of all primary central nervous system lymphoma. The objective of this report is to report a low-grade primary pituitary lymphoma, diagnostic problems and to give more evidence about the evolution of this rare disease. A 49 y.o. woman was referred to our clinic with symptoms of hypopituitarism. A diagnostic work-up showed mild anemia, an erythrocyte sedimentation rate of 122 mm/h and a negative Elisa test for HIV. Panhypopituitarism was confirmed and the MRI showed a 20 mm sellar and suprasellar enhancing mass with a thickening of the pituitary stalk, chiasmal compression and bitemporal hemianopsia. She underwent transsphenoidal resection only 10 months later for non medical reasons. During this period she was clinically asymptomatic on hormonal replacement therapy. A new MRI showed regression of the suprasellar extension and invasion to the left cavernous sinus. A firm and infiltrative mass was found during transsphenoidal surgery, and only partial resection was performed. Biopsy showed a low-grade lymphoplasmacytic lymphoma. Staging was negative for other localizations. She was given chemotherapy and localized radiotherapy. Four years after surgery, the sellar MRI showed a 10 mm residual sellar mass with the persistence of a cavernous sinus invasion and she is considered to be in remission. The neurosurgeon and clinician should consider primary pituitary lymphoma as a potential cause of a sellar mass, especially in the presence of diabetes insipidus and an enhancing invasive mass. Neurosurgical biopsy is crucial for a correct diagnosis and prognosis could be better than classic CNS primary lymphomas.     

The clinical significance of MIB-1 labeling index in pituitary adenomas

Pituitary adenomas are unique in several ways—they are rarely malignant and yet can be invasive of several compartments. Recurrences in tumors with bland histological features that have been radically excised are a reason for frustration faced by endocrinologists and neurosurgeons in treatment of pituitary adenomas. Several attempts have therefore been made to determine the growth potential of pituitary adenomas. The aim of the present study was to define the biological significance of the MIB-1 labelling index (MIB-1 LI) in pituitary adenomas. The study included 159 cases of surgically treated pituitary adenoma seen in a single institution. MIB-1 LI was not found to be related to age or gender. The mean MIB-1 LI for clinically functional adenomas was marginally higher than that for clinically non-functional adenomas. There was a significant difference in the MIB-1 LI for tumors with a maximum diameter of more than 4 cm at a MIB-1 LI of ≥2%, however this difference was not statistically significant at a higher MIB-1 LI cut off value of >3%. The mean MIB-1 LI was significantly higher in tumors causing hydrocephalus and in those with cavernous sinus invasion and not when invasion was defined as invasion by tumor in any direction. We conclude that large pituitary macroadenomas, tumors filling the third ventricle causing hydrocephalus and tumors with true cavernous sinus invasions are more likely to have a higher proliferation index. Close follow up of tumors showing these imaging features would be recommended.     

Does first-line surgery still have its place in the treatment of acromegaly?

Transsphenoidal surgery is currently the first-line treatment of acromegaly. Remission is observed in 80 to 90% microadenomas, 50 to 60% non-invasive macroadenomas, and less than 20% invasive macroadenomas. Predictive factors include age, maximal size of the adenoma, cavernous sinus invasion, initial hormone levels and neurosurgeon's experience. Complications are rare, with about 5% definitive diabetes insipidus and 10% of new anterior pituitary hormone deficits. Somatostatin agonist pretreatment can be proposed as it decreases tumor volume in about 25% cases and might reduce the rate of immediate postsurgical complications; however, there is no obvious difference in surgical remission rate whether patients are pretreated or not. Debulking surgery can also be proposed in very large macroadenomas incompletely controlled by somatostatin agonists or resistant to medical treatment, as it was shown to facilitate somatostatin agonist efficacy in more than 50% cases.