术前MRI判断垂体大腺瘤侵袭海绵窦的研究

目的：探讨术前M RI多种扫描征象在预测垂体大腺瘤是否侵袭海绵窦的实用价值。方法垂体大腺瘤患者212例，手术前均行M RI多种序列扫描，分别观察以下4个征象：（1）冠状位T2加权像上表现为低信号的海绵窦内侧壁的完整性；（2）冠状位T1加权像上海绵窦内颈内动脉的环状增强影；（3）肿瘤是否突破颈内动脉外切线；（4）肿瘤是否长入海绵窦内颈内动脉下间隙。另外，测量肿瘤包绕颈内动脉所成的角度，并以ROC曲线进行分析。手术中神经内镜直视下观察海绵窦内侧壁是否完整，以确定是否具有侵袭性。结果212例垂体大腺瘤，术中证实侵袭海绵窦36例，4个征象综合起来判断时敏感性和特异性分别为91．7％和97．2％，阳性预测值达92．8％。当颈内动脉被包绕达135°以上时，海绵窦被侵袭的可能性大，敏感性和特异性分别是88．9％和84．1％。结论综合应用多种M RI扫描征象对于预测垂体大腺瘤是否侵袭海绵窦具有很高的实用价值；术前准确判断垂体大腺瘤是否侵袭海绵窦将有助于优化治疗计划。

A Study of Preoperative MRI Evaluation forCavernous Sinus Invasion by Pituitary Macroadenoma

Objective To analyze the relation between cavernous sinus and pituitary macroade‐noma in various magnetic sequences imaging (M RI) criteria and to identify the prediction accuracy of pre‐operative M RI for cavernous sinus (CS ) invasion by pituitary macroadenoma . Methods We retrospec‐tively reviewed the preoperative MRI of 212 patients with pituitary macroadenoma who underwent endo‐scopic transsphenoidal surgery . The following MR signs were assessed and compared with intraoperative findings :(1 ) Integrity of the medial wall of cavernous sinus with a hypointense signal on coronal T2‐weighted image;(2) Presence of entire rim‐enhancement around the intracavernous internal carotid ar‐tery (ICA) on T1‐weighted image ;(3) The relationship between the edge of the tumor and the lateral in‐tercarotid lines ;(4) Relationship between tumor and inferior space of internal carotid in cavernous sinus . Moreover ,the angle of tumor encasement around the intracavernous ICA was analyzed by Receiving Op‐erative Characteristic curve . Results T he intraoperative finding confirmed CS invasion in 36 of 212 pa‐tients with pituitary macroadenoma . When four MRI signs were used in combination ,the sensitivity and specificity ,and positive predictive value were 91 .7% ,97 .2% ,and 92 .8% ,respectively . A threshold value of 135° was associated with a high probability of CS invasion ,with a sensitivity of 88 .9% and a spe‐cificity of 84 .1% . Conclusions The combination of various preoperative MRI signs may be helpful in evaluating the presence of CS invasion . Comprehensive therapeutic plan may be optimized if preoperative determination of the presence of CS invasion is performed .