MRI对垂体柄阻断综合征的诊断价值

目的 探讨垂体柄阻断综合征(PSIS)的MRI特点及其临床意义.方法 21例PSIS患者行MR扫描及激素水平检测.所有患者均行液体衰减反转恢复(FLAIR)序列T1WI及快速SE(FSE)序列T2WI,8例加扫FLAIR T1WT脂肪抑制序列,分析垂体柄、垂体前叶形态和垂体后叶信号变化.结果 21例患者的基础生长激素(GH)水平为0.03～1.50μg/L,GH激发试验峰值为0.13～4.14μg/L,均为完全GH缺乏.其中17例为多垂体激素缺乏(CPHD),4例为单一性GH缺乏(IGHD).患者垂体前叶高度为1.0～3.0 mm,平均(1.9±1.2)mm,均有不同程度的缩小.18例在正中矢状面及冠状面上垂体柄均未见明确显示,3例表现为不连续的细线状.所有患者垂体后叶均未见正常高信号,19例表现为垂体后叶高信号异位在第三脑室漏斗隐窝,2例合并有尿崩症的患者表现为垂体后叶高信号消失,也未见异位的高信号.结论 PSIS在MRI上有特征性表现,结合临床激素水平可明确诊断.

Diagnostic value of MRI in pituitary stalk interruption syndrome

Objective To study characteristic findings and the diagnostic value of MRI in pituitary stalk interruption syndrome (PSIS). Methods Twenty-one patients with PSIS were included. Small field of view (FOV) MR1 scanning and clinic hormone detection were performed in all patients. Moreover, fluid attenuated inversion recovery (FLAIR)T,1 WI with fat-suppression sequence was performed in 8 cases. The appearance on FLAIR T1 WI and T2 WI were recorded. The shape of pituitary stalk and antehypophysis, and the signal intensity of posthypophysis were analyzed simultaneously. Results Growth hormone deficiency (GHD) was confirmed by clinic hormone detection in all 21 cases. The level of basal GH varied from 0. 03 μg,/L to 1.50 μg/L. The peak value under GH provocation was from 0. 13 μg/L to 4. 14 μg/L, and the GH was absolute default in all patients. Seventeen cases of them were combined pituitary hormone deficiency (CPHD), and 4 cases were isolated growth hormone deficiency (IGHD). The height of antepituitary was in the range from 1 mm to 3 mm, and the average value was (1.9±1.2) mm. Pituitary stalk was absent in 18 cases and showed as linear and discontinuous stalk in the other 3 cases. The high signal intensity was invisible in normal position in all cases, the high signal intensity spot in the region of infundibular recess of the third ventricle was shown in 19 cases, while it could not be found anywhere in 2 patients with diabetes insipidus. Conclusion PSIS often shows characteristic appearance on MRI, and a definite diagnosis can be made by using MRI combined with clinic hormone detection.