垂体腺瘤患者蝶鞍形态的MRI研究

目的通过对垂体腺瘤病人的蝶鞍进行MRI测量,分析相关的影响因素和临床意义。方法连续收治并筛选垂体大腺瘤40例,直径大于10 mm,鞍底轮廓均完整。取正中矢状位和冠状位的蝶鞍MRI进行测量,主要指标包括鞍长、鞍面、鞍凸、鞍角、鞍窗、肿瘤高度、鞍上和鞍下部分肿瘤的高度、鞍上和鞍下部分肿瘤的面积等,将其相互对比,并与蝶窦的气化程度及肿瘤切除程度作比较。结果凸型鞍底(鞍角<90°)为29例,弧型(鞍角为90°~150°)10例,扁平型(鞍角>150°)1例。肿瘤大小与鞍长、鞍面、鞍窗均存在明显正相关(P<0.01),其中肿瘤大小与鞍长的相关性最为显著。鞍下部分肿瘤高度与鞍凸呈正相关(P<0.05),两者均与蝶窦气化类型之间无明显关系。鞍凸和鞍角均为较独立的观测指标,与鞍面、鞍窗及鞍长关系不大。结论垂体腺瘤越大,蝶鞍也趋于增大,特别是使鞍底更为隆突。在半鞍型蝶窦者,尽管鞍底较为扁平,但是因为伴有较大的鞍长和鞍窗,展开鞍底开窗手术操作的难度并不大。     

Heidenhain—Azan染色在垂体腺瘤诊断的应用

脑垂体腺瘤是一种常见的肿瘤,组织学上根据构成肿瘤的细胞种类可分为嫌色性细胞腺瘤、嗜酸性细胞腺瘤和嗜碱性细胞腺瘤三种。在临床治疗上往往需要将嗜酸性细胞腺瘤区分为生长素细胞腺瘤和泌乳素细胞腺瘤。常规HE染色不能分别显示这些细胞,PAS三色法也只能显示嫌色细胞,嗜酸性细     

动态增强MRI定量与半定量分析在直肠癌术前T、N分期中的应用价值

目的 评估动态增强MRI(DCE-MRI)定量、半定量分析在直肠癌术前T、N分期诊断中的应用价值。方法 回顾性分析山西省肿瘤医院MR室2014年7月—2014年11月经肠镜病理证实的27 例直肠癌患者影像资料。其中男18例,女9例,年龄45～73岁,此前均未经任何治疗。均于术前行DCE-MRI,用Omni-Kinetics专用灌注软件进行后处理,同时获得容量转移常数(K^trans)、速率常数(K_ep)、细胞外血管外间隙容积比(V_e)等定量参数,以及达峰时间(TTP)、曲线下面积(AUC)、最大浓度(Max Conc)、最大斜率(Max Slope)等半定量参数。对正常肠壁与病变段肠壁的定量、半定量参数行独立样本t检验;采用秩和检验比较各定量、半定量参数在直肠癌术后病理T、N分期的差异,判断各参数的诊断价值。应用ROC曲线分析定量参数在T、N分期中的最佳诊断界点及敏感性、特异性。根据TNM对患者进行分期。结果 正常肠壁与病变段肠壁的K^trans值[(0.28±0.14)min^-1 vs (1.33±0.86)min^-1]、K_ep值[(1.41±0.67)min^-1 vs (3.56±0.72)min^-1]、Max Conc(0.17±0.02 vs 0.29±0.09)、AUC(0.11±0.07 vs 0.23±0.11)比较,差异均具有统计学意义(t=-6.270、-11.359、-2.487、-2.803,P值均＜0.05)。在T分期为T1～2的早期组与T3～4的晚期组间K^trans值[0.66(0.12～1.35)min^-1 vs 2.15(0.84～2.96) min^-1]、K_ep值[2.51(0.12～5.65)min^-1 vs 4.05(3.18～6.68) min^-1]比较,差异均有统计学意义(Z值分别为-4.077、-2.281,P值均＜0.05)。N分期中,淋巴结无转移组的K^trans值(1.01±0.73)、V_e值(0.29±0.18)、TPP(0.93±0.35)均低于转移组(1.75±0.84、0.54±0.29、1.14±0.15,差异均有统计学意义(Z值分别为-2.433、-2.832、-2.496,P值均＜0.05)。结论 DCE-MRI定量及半定量参数在判断正常肠壁与病变段肠壁、直肠癌的术前T、N分期方面和病理有较高的相关性,对诊断有一定参考价值。定量参数K^trans值、V_e值最佳诊断界点为直肠癌T、N分期提供了较高的敏感性与特异性。     

垂体腺瘤对颈内动脉影响的MRI观测

目的：旨在探索颈内动脉与垂体腺瘤的关系。方法：通过对３０例垂体腺瘤患者ＭＲＩ的观测,测量颈内动脉在海绵窦段的间距。结果：间距２０．１ｍｍ,而且随垂体腺瘤左右径的增大,颈内动脉间距随之增大,肿瘤对颈内动脉向外侧推移、包裹、粘连可能性亦增加。结论：结果表明临床经鼻—蝶窦垂体腺瘤手术时,向两侧海绵窦方向探查和刮除腺瘤距中线平均不应超过１ｃｍ。     

垂体微腺瘤的MR诊断

目的总结垂体微腺瘤不同的生长方式,提出垂体微腺瘤的MR诊断依据.方法回顾分析了93例垂体微腺瘤MR平扫、动态增强和动态后T1WI的资料,对垂体微腺瘤的生长方式和特征进行归纳和分析.结果依据其生长方式将垂体微腺瘤分为3型:偏心型55例(59%),中心型25例(27%),鞍底型13例(14%).诊断依据:(1)垂体内部局限性低信号;(2)垂体两侧不对称大于1.4mm;(3)垂体中间向上膨隆大于2.3mm;(4)垂体高径大于8mm.结论利用垂体微腺瘤的分型,掌握其生长特点,全面考虑临床表现和垂体内分泌的生化检查.在检查方法上,要动态增强扫描和常规增强扫描相结合.     

垂体ACTH细胞腺瘤的免疫电镜研究

5 cases of pituitary adenomas associated with Cushing's disease or Nelson's syndrome were studied with electron microscopy and immunoelectron microscopy by using protein A--gold complex. Diversified ultrastructure was displayed in these tumors, among which 4 revealed presence of ACTH positive secretory granules. These granules were round or polyhedric in shape, varied in number, size and electronic density. Bundles of microfilaments could be seen in the tumor cells frequently, which were of the highest diagnostic value. There was no significant difference found in ultrastructure and immunocytochemical reaction of adenomas in Cushing's disease and Nelson's syndrome.     

磁共振动态增强参数对女性乳腺病变的诊断意义

目的:探究MRI动态增强参数对女性乳腺疾病鉴别诊断价值.方法:收集本院2019年2月至2021年10月收治的101例乳腺疾病患者的资料.以病理检查结果为"金标准",对比良、恶性乳腺病变的MRI动态增强参数值,分析MRI动态增强诊断乳腺疾病的准确性、敏感性和特异性.结果:101例乳腺病变患者中良性病灶69例(68.32％...     

血清PRL水平与MRI扫描垂体催乳素瘤的对比分析及临床应用

目的:通过血清催乳素(PRL)含量与MRI扫描垂体催乳素瘤的对照研究,观察垂体催乳素瘤的特征,可进一步评价垂体催乳素瘤的生物学行为。方法:搜集确诊垂体催乳素瘤患者66例,同时行垂体MRI常规序列扫描及同位增强扫描。结果:微腺瘤患者中女性多见;好发在垂体前叶后部两侧。大腺瘤患者中男性多见;性腺功能减低发生率高;侵袭性腺瘤发生率高、复发率高。催乳素瘤的大小与血清PRL水平呈直线相关性(r=0.4372,P<0.01)。结论:血清PRL增高,结合MRI动态增强扫描可准确显示垂体催乳素瘤的形态及位置,对照研究可初步评估肿瘤的生物学行为,为临床诊断治疗提供重要依据。     

The value of diffusion-weighted and dynamic contrast-enhanced imaging in the diagnosis of thymic epithelial tumors

Background: Thymic epithelial tumors (TETs) are clinically the most frequently encountered neoplasm of the prevascular mediastinum in adults. The role of chest magnetic resonance (MR) imaging has been increasingly stressed thanks to its excellent contrast resolution, freedom from ionizing radiation, and capability to provide additional information regarding tumors'' cellular structure and vascularity.Methods: This study aimed to establish the relationship between the MR findings and pathological classification of TETs, focusing on diffusion-weighted (DW) and dynamic contrast-enhanced (DCE) imaging. This retrospective cross-sectional study included 44 TET patients who underwent chest MR scanning. The tumors were classified into three groups according to the WHO classification: low-risk thymoma (LRT), high-risk thymoma (HRT), and non-thymoma (NT). Along with morphological characteristics, the apparent diffusion coefficient (ADC) value, time-intensity curve (TIC) pattern, and time to peak enhancement (TTP) of the tumors were recorded and compared between the three groups.Results: A smooth contour and complete or almost complete capsule were suggestive of LRTs. The median ADC value of the 44 tumors was 0.95 × 10^-3 mm²/sec. Among the three groups, LRTs had the highest ADC values, while NTs had the lowest. The differences between the ADC values of the three groups were statistically significant (p = 0.006). Using an ADC cutoff of 0.82 × 10^-3 mm²/sec to differentiate between LRTs and tumors of the two remaining groups, the area under the curve was 0.775, sensitivity was 100%, specificity was 50%, and accuracy was 65.91%. The washout (type 3) TIC pattern was the most prevalent, accounting for 45.45% of the population; this pattern was also predominantly observed in LRTs (71.43%). Although the median TTP of LRTs was lower than that of HRTs or NTs, no statistically significant differences were found between the TTPs of the three groups (p = 0.170).Conclusions: MR is a good imaging modality to preoperatively assess TETs. Morphological features, ADC value, TIC pattern, and TTP are helpful in preoperatively predicting TET pathology.     

垂体促甲状腺素腺瘤的临床病理分析

目的 研究垂体促甲状腺素(TSH)腺瘤的临床及病理学特点。方法 利用光镜、电镜观察和免疫组织化学链霉素抗生物素蛋白一过氧化物酶法(SP法),结合临床资料对7例垂体TSH腺瘤进行临床病理分析。结果 7例患者均有甲状腺功能亢进的临床表现,血浆FT3、FT4、T3、T4均增高,血浆TSH不被抑制。蝶鞍MRI检查均为垂体大腺瘤或巨大腺瘤(直径2～5cm),光镜下显示5例为嫌色细胞性腺瘤,1例为弱嗜酸和嫌色细胞性腺瘤,1例为嗜酸细胞性腺瘤。免疫组织化学染色7例TSH强阳性,1例合并泌乳素阳性,2例合并生长激素阳性,3例合并散在生长激素和泌乳素阳性,Ki-67标记7例阳性率为0～0．4％,p53标记7例均为阴性。结论 7例垂体TSH腺瘤虽然都为大腺瘤和巨大腺瘤,1例侵犯额叶底部和第三脑室,但它们的增殖指数均在正常范围,肿瘤的复发与肿瘤侵犯周围组织不能彻底切除有关。     

Signet ring-like cells in pituitary adenoma

We describe a case of non-functioning pituitary adenoma in a 35-year-old woman with a prior history of fertility problems. The patient had received clomiphen citrate and human chorionic gonadotrophin for 3 years. Histological examination of the tumor revealed signet ring-like cell areas admixed with minor conventional round-polygonal neoplastic cells. The two populations of tumor cells showed strong immunoreactivity for chromogranin and synaptophysin. The clinicopathologic features and diagnostic difficulties of this rare entity are discussed.     

Null cell adenoma of the human pituitary

Summary Among 343 surgically-removed pituitary adenomas, 56 tumors were unassociated clinically or biochemically with increased hormone secretion and contained no adenohypophysial hormones by the immunoperoxidase technique, except for 10 cases in which a few scattered cells showed positive immunostaining for -TSH or -FSH, -EH, prolactin and/or -subunit. These tumors were chromophobic adenomas with no PAS, lead hematoxylin or carmoisine positivity and electron microscopy failed to reveal their morphogenesis. The term null cell adenoma of the pituitary is proposed to designate this tumor type. This term recognizes the most obvious features of these tumors: the absence of markers which would permit the disclosure of their cellular origin. Null cells are also found in the nontumorous adeno-hypophysis, suggesting that null cell adenomas derive from preexisting nonneoplastic null cells. The question of whether pituitary null cells are hormonally inactive committed precursors, uncommitted stem cells or dedifferentiated cells remains to be elucidated.This work was supported in part by Grant MA-6349 of the Medical Research Council of Canada and Grant 1 R01 CA 21905-01 awarded by the National Cancer Institute, DHEW     

小脑血管母细胞瘤的MR诊断

目的探讨血管母细胞瘤的MRI诊断。方法回顾性分析经手术病理证实的24例小脑血管母细胞瘤，探讨其MRI表现。结果18例血管母细胞瘤位于小脑半球，6例位于小脑蚓部。15例表现为大囊小结节型，结节强化明显；9例表现为实质型；24例瘤内或瘤周均可见血管流空信号。本组MRI正确诊断22例，准确率为91．67％。结论MRI是诊断小脑血管母细胞瘤的有效检查方法，但不典型者需与胶质瘤、转移瘤、动静脉畸形等鉴别。     

磁共振对胎盘植入的诊断价值

目的探讨胎盘植入的磁共振影像学特点,评价磁共振诊断胎盘植入的价值。方法回顾性分析临床拟诊胎盘植入的29例产妇MRI影像学资料特征,并与手术和/或临床综合诊断结果比较,分析MRI鉴别胎盘粘连和植入的敏感性、特异性和准确性。结果胎盘植入的MRI表现为蜕膜层低强度信号发生局部缺失,子宫肌层变薄,动态增强植入胎盘与子宫基层一致性明显强化,部分胎盘边缘强化明显,少数可见滋养血管。MRI鉴别胎盘植入(含穿透)与粘连敏感性、特异性和准确性分别为85%、80%和82%。结论 MRI软组织分辨率高,结合增强能明确胎盘植入并判断肌层受侵的情况,对胎盘植入的诊断有较高的临床价值。     

MRI常规序列及3D-SPACE序列在先天性子宫发育异常中的临床应用价值

目的探讨MRI常规序列及3D-SPACE序列在先天性子宫发育异常分型诊断中的临床应用价值。方法回顾性分析30例先天性子宫发育异常患者的MRI和临床资料,参照美国生殖学会的标准进行先天性子宫发育异常的分型诊断。结果30例先天性子宫发育异常的患者中纵隔子宫19例（完全性纵隔子宫11例,不完全性纵隔子宫8例）,双子宫3例,单角子宫2例,残角子宫1例,双角子宫2例,弓形子宫3例,并经临床或手术证实,准确率达100％。结论MRI常规序列及3D-SPACE序列可对先天性子宫发育异常的类型作出准确的诊断,是先天性子宫发育异常的最佳无创性影像检查方法。     

MRI弥散加权成像表观扩散系数在低、高级别脑膜瘤鉴别诊断中的应用

目的 探讨常规MRI结合弥散加权成像(DWI)中表观扩散系数(ADC)在低、高级别脑膜瘤的鉴别诊断中的临床应用价值。方法 回顾性分析中国科学技术大学附属第一医院2018年1月-2019年8月68例脑膜瘤患者的临床资料,男29例、女39例,年龄24~78(48.62±10.28)岁。其中WHOⅠ级脑膜瘤52例(低级别组),WHO Ⅱ级12例、WHO Ⅲ级4例(高级别组)。患者术前均行常规MRI结合DWI检查。观察两组患者的MRI征象以及DWI特点;比较两组患者脑膜瘤实质和瘤周水肿部位ADC值以及肿瘤实质与对侧脑白质的相对表观扩散系数(rADC),利用ROC曲线分析最佳rADC值对低、高级别脑膜瘤的诊断效能。结果 两组患者基线资料差异均无统计学意义(P值均＞0.05)。高级别组脑膜瘤边缘不规整、强化不均匀、边缘水肿区、脑膜尾征和囊变、坏死、钙化区等影像学征象发生率明显高于低级别组脑膜瘤,差异均有统计学差异(P值均＜0.05)。52例低级别组脑膜瘤中,有38例DWI、ADC均呈等信号,14例DWI呈稍高信号、ADC呈稍低信号;16例高级别组脑膜瘤实质部分DWI呈高信号、ADC呈低信号,而囊变、出血坏死、钙化区呈高信号。低级别组、高级别组脑膜瘤肿瘤实质部分 ADC值分别为(0.94±0.14)×10^-3、(0.73±0.11)×10^-3 mm²/s,rADC值分别为(1.16±0.18)×10^-3、(0.95±0.14)×10^-3 mm²/s,低级别组脑膜瘤实质部分ADC和rADC值均明显高于高级别组脑膜瘤,差异均有统计学意义(t=5.491、4.277, P值均<0.01);低级别组、高级别组脑膜瘤的瘤周水肿区域ADC分别为(1.82±0.19)×10^-3、(1.88±0.21)×10^-3 mm²/s,rADC值分别为(2.29±0.24)×10^-3、(2.38±0.29)×10^-3 mm²/s,差异均无统计学意义(P值均>0.05);以rADC值诊断低级别组、高级别组脑膜瘤的最佳临界点为1.035×10^-3 mm²/s,其灵敏度为88.5%,特异度为87.5%。结论 常规MRI结合DWI中ADC值的测量对低、高级别脑膜瘤的鉴别诊断具有重要临床应用价值。     

MRI在胎儿泌尿系统异常中的诊断价值

目的探讨MRI在胎儿泌尿系统异常中的诊断价值。资料与方法收集2012年8月～2014年4月超声（US）怀疑胎儿泌尿系异常孕妇57例,年龄19-38岁,平均28±3岁;孕龄23-36w,平均29±3.4w。产前超声（US）检查后72h内行MRI检查,将US、MRI结果与出生后或引产后结果对照。结果单侧肾脏缺如7例,异位肾2例,马蹄肾3例,肾囊性病变10例,输尿管上段扩张35例。结论MRI对胎儿泌尿系统异常具有较高的诊断价值。