Increased pituitary volume in patients with established bipolar affective disorder

Hypothalamic-pituitary-adrenal (HPA) axis dysfunction has been demonstrated in bipolar disorder (BD), but previous magnetic resonance imaging (MRI) studies of pituitary gland volume in BD have reported variable findings. In this MRI study we investigated pituitary volume in 26 patients with established bipolar I disorder (8 males and 18 females, mean age = 38.4 years) and 24 matched controls (7 males and 17 females, mean age = 38.7 years). The BD patients had a significantly larger pituitary volume as compared with controls, but there was no association between pituitary volume and illness duration, number of manic/depressive episodes, daily medication dosage, family history, or clinical subtype (i.e., psychotic and nonpsychotic). Pituitary volume was larger in females than in males for both groups. These results support previous neuroendocrine findings that implicate HPA axis dysfunction in the core pathophysiological process of BD.     

MRI动态增强扫描诊断垂体微腺瘤的临床研究

目的 评价增强高场MRI动态对比增强扫描诊断垂体微腺瘤的临床应用价值.方法 回顾性分析85例经手术或临床证实的垂体微腺瘤的MR影像资料.所有病例均行SE序列T1加权T2加权扫描、动态增强扫描及延迟增强扫描.结果 常规T1WI扫描垂体异常信号显示12例,检出率(12/85)14.1%;T2WI显示垂体内见异常信号者25例,检出率(25/85)29.4%;增强动态MR垂体见异常信号81例,检出率(81/85)95.3%;MR延迟增强垂体异常信号66例,检出率(66/85)77.6%.经χ2检验,MR垂体微腺瘤检出率常规T1WI扫描与常规T2WI扫描之间差异无显著性(P＞0.05);动态MR扫描与常规T1WI扫描和T2WI扫描之间差异均有非常显著性意义(P＜0.05);动态MR扫描检出率明显高于延迟增强的检出率,但统计学无显著性差异.结论 垂体动态MR能明显提高垂体微腺瘤诊断的检出率,特别是当临床怀疑垂体微腺瘤,而MR平扫阴性者,应常规进行动态MR及延迟MR增强扫描,延迟MR增强扫描的检出率尽管不如动态MR增强扫描,但其能观察整个垂体的全貌,弥补单纯动态的不足,也应列为动态MR后的常规检查.     

高低磁场MRI影像导航在垂体腺瘤手术中的应用及比较

目的探讨术前高低磁场MRI图像进行垂体腺瘤神经导航手术的作用。方法对42例垂体腺瘤患者进行MRI扫描,图像在导航系统工作站三维重建,制定出手术计划,标记重要结构,导航定位并指导手术操作。结果术中神经导航定位精确,注册误差在0～1.9 mm。术后MRI复查肿瘤全切除者34例(80.9%)、次全切除者8例(19.1%)。结论垂体腺瘤行导航手术最适合,高或低磁场MRI提供影像导航无明显差异。     

大及巨大垂体腺瘤经蝶入路切除术后疗效评估-MRI动态观察

目的分析比较大和巨大垂体腺瘤经蝶手术后不同时期核磁共振检查的影像学特点,探讨MRI对手术疗效评估的最佳时机。方法追踪、随访直径≥2cm垂体腺瘤72例,其中PRL瘤37例,无功能性腺瘤25例,GH腺瘤2例,ACTH腺瘤2例,多分泌激素腺瘤6例。分别于术后早期(术后1～2周)、三个月、半年核磁共振检查,其中45例MRI随访一年以上,进行动态观察比较。结果72例术后早期MRI复查确定瘤影完全消失34例(47．2%)；11例术后早期MRI检查报告残留,半年后复查3例消失,8例残留；27例(37．5%)术后早期MRI不能明确判定疗效,半年后复查完全切除22例,5例残留。45例术后随访一年,其MRI表现与术后半年的表现相似。结论术后半年的MRI能较好的判断手术效果,有利于术后辅助治疗方案的选择。     

抑郁症患者脑的磁共振研究

目的;采用磁共振技术（MRI）分析抑郁症患者的脑结构改变。方法：以抑郁症患者32例为病例组,正常23例为对照组,作头颅磁共振扫描。结果：病例组第3脑室横径,双侧外侧裂宽度显著增宽,透明中隔至额极距离减少。结论：抑郁症患者额、颞叶均明显萎缩。     

Anatomic location and laterality of MRI signal hyperintensities in late-life depression

OBJECTIVES: Evidence is mounting linking cerebrovascular disease with the development of major depression in the elderly. Lesions in both white and gray matter have been associated with geriatric depression. In addition, the literature on poststroke depression suggests that left-sided lesions are associated with depression. We sought to examine the severity and location of white- and gray-matter lesions in a group of elderly depressives and nondepressed control subjects. METHOD: 115 depressed patients (69 with late onset, 46 with early onset) and 37 controls, all over age 45, received magnetic resonance imaging (MRI). Semiquantitative severity ratings and quantitative measurements of number and size of MRI hyperintensities were obtained, and groups were compared using Cochran-Mantel-Haenszel (CMH) analyses and repeated-measures analyses of covariance adjusting for age. RESULTS: Late-onset depressed patients had more severe hyperintensity ratings in deep white matter than early-onset patients and controls. Late- and early-onset patients had more severe subcortical gray-matter hyperintensities (particularly in the putamen) compared with controls. Left-sided white-matter lesions were significantly associated with older age of depression onset, whereas right-anterior white matter and left-subcortical lesions (particularly in the putamen) were associated with melancholia in the depressed group. CONCLUSION: These findings extend previous reports of an association between cerebrovascular disease and depression, as well as recent studies showing lateralized lesion involvement in geriatric depression. Such vascular pathology may disrupt neural pathways involved in affective processing and the maintenance of a normal mood and psychomotor state.     

垂体的膜性结构及其临床意义

目的 研究垂体的被膜层次,探讨其和侵袭性垂体腺瘤之间的关系.方法 取8例胎儿的鞍区标本,经冠状、矢状位连续切片,HE和Masson染色后,观察并测量各层膜性结构;另取成人标本10例,暴露鞍区各膜性结构,行解剖学观察和测量.结果 垂体表面由固有膜和垂体囊共同包裹,所有标本中该两层均完整.腺垂体表面该两层膜间尚存潜在腔隙;而随着腺垂体向神经垂体过渡,两膜渐紧贴,在神经垂体表面二者紧密粘连,组织学上难以分清.垂体囊厚度不均,其上壁、上外侧和下壁厚度较薄,而下外侧壁较厚;固有膜厚度均匀.海绵窦(CS)内侧壁同其他各壁一样也是双层膜性结构,其外层由垂体囊的外侧部构成;而内层为纤维层,从其上还向CS内发出很多结缔组织纤维,覆盖窦内各神经血管外,同时将窦分隔成很多静脉腔隙.结论 CS内侧壁是由垂体囊外侧壁(硬膜结构)和纤维层共同构成的双层结构.侵袭性垂体腺瘤可能是腺瘤向鞍旁扩展造成CS内侧壁的适形性扩展而形成的影像学假象,而肿瘤和垂体囊之间尚存在外科手术界线.     

Ultrastructure of oncocytic adenoma of the human pituitary gland

Summary Two cases of oncocytic adenoma occurring in the pituitary are reported. Both were men aged 40 and 50 years respectively and there was no evidence of endocrine abnormality.In both the tumours many cells showed abundant acidophilic finely granular cytoplasm which had not stained positively with PAS-orange G stain. Electron microscopically the cells contained numerous mitochondria associated with marked reduction of other cytoplasmic organelles including the secretory granules.     

A cross-sectional and follow-up voxel-based morphometric MRI study in adolescent anorexia nervosa

The objective was to examine whether cerebral volumes are reduced, and in what regions, in adolescents with anorexia nervosa and to study changes after nutritional recovery. Twelve anorexia nervosa (DSM-IV) patients aged 11-17 consecutively admitted to an Eating Disorders Unit were assessed by means of psychopathological scales, neuropsychological battery and voxel-based morphometric (VBM) magnetic resonance imaging at admission and after 7 months’ follow-up. Nine control subjects of similar age, gender and estimated intelligence level were also studied. The two groups showed differences in gray matter (F = 22.2; p < 0.001) and cerebrospinal fluid (CSF) (F = 21.2; p < 0.001) but not in white matter volumes. In anorexic patients, gray matter volume correlated negatively with the copy time from the Rey Complex Figure Test. In the regional VBM study several temporal and parietal gray matter regions were reduced. During follow-up there was a greater global increase in gray matter (F = 10.7; p = 0.004) and decrease in CSF (F = 22.1; p = 0.001) in anorexic patients. The increase in gray matter correlated with a decrease in cortisol (Spearman correlation = −0.73; p = 0.017). At follow-up there were no differences in global gray matter (F = 2.1; p = 0.165), white matter (F = 0.02, p = 0.965) or CSF (F = 1.8; p = 0.113) volumes between both groups. There were still some smaller areas, in the right temporal and both supplementary motor area, showing differences between them in the regional VBM study. In conclusion, in adolescent anorexic patients gray matter is more affected than white matter and mainly involves the posterior regions of the brain. Overall gray matter alterations are reversible after nutritional recovery.     

Anatomical MRI study of corpus callosum in unipolar depression

Previous studies have suggested abnormal cerebral lateralization in major depressive disorder (MDD). Few controlled MRI studies have investigated the corpus callosum (CC), the largest commissura connecting the two cerebral hemispheres, in MDD. This study investigated anatomical abnormalities in the CC and its subdivisions in MDD patients. Twenty-two unmedicated MDD patients and 39 healthy subjects underwent brain magnetic resonance imaging (MRI). Measurements of the CC and its sub-regions were performed with a semi-automated software (NIH Image, version 1.62). ANCOVA with age, gender, and intra-cranial volume (ICV) as covariates showed no significant differences in CC measurements between patients and controls (df=1,56; p>0.05). However, patients with familial MDD had a significantly larger middle genu area (F(1,45)=4.252; p=0.045) compared to healthy controls, and significantly larger middle genu (F(1,13)=5.366; p=0.037), anterior splenium (F(1,13)=6.27; p=0.026), and middle splenium areas (F(1,13)=4.706; p=0.049) compared to patients with non-familial MDD. Although preliminary, our findings suggest that anatomical abnormalities in CC may be restricted to patients with familial MDD, with possible enlargement of CC in this particular sub-group. The possible role of callosal abnormalities in the pathogenesis of mood disorders should be further examined.     

Neuroanatomical substrates of depression in the elderly

Summary The etiology of depression in the elderly is poorly understood. In this study, magnetic resonance imaging was used to evaluate the role of subcortical structures in the pathophysiology of depression in the elderly. Elderly depressed patients were found to have smaller caudate nuclei, smaller putaminal complexes and in increased frequency of subcortical hyperintensities compared with normal, healthy controls. These findings were more pronounced in patients with lateonset depression. Based on these findings, the authors discuss the role of the basal ganglia in the pathophysiology of depression in the elderly.     

阿尔茨海默病脑磁共振研究

目的 了解Ａｌｚｈｅｉｍｅｒ病（ＡＤ）脑结构性变化的特点及与健康老人增龄性改变的差异。方法 对２２例ＡＤ和２９例健康老人分别按年龄为６０～６５岁、６６～７０岁和７０岁以上三组,ＡＤ为ａｄ１、ａｄ２和ａｄ３组,健康老人为ｎｏｒ１、ｎｏｒ２和ｎｏｒ３组。全部对象作ＭＲＩ检查。结果 ｎｏｒ３的灰质体积、总脑脊液体积及右侧海马体积与ｎｏｒ１和ｎｏｒ２相比有显著差异;与健康老人相比,ＡＤ的灰质体积,双侧海马体积显著降低,而总脑脊液、脑室外脑脊液、侧脑室、三脑室和四脑室体积显著升高。结论 与健康老人增龄性变化相比,ＡＤ脑结构性改变的涉及范围广,变化幅度大。     

原发性高颅压的垂体及蝶鞍影像学形态变化(附28例分析)

目的　研究原发性高颅压病人垂体和蝶鞍形态变化与病程的关系。方法　回顾性分析原发性高颅压 2 8例病人的临床资料 ,并对垂体和蝶鞍形态变化分别分级。结果　本组垂体形态正常 3例 ,垂体 /垂体窝≥ 50 %者 6例 ,≤ 50 %者 1 0例 ,空蝶鞍 9例。蝶鞍形态正常 1 0例 ,蝶鞍稍扩大 1 2例 ,明显扩大 6例。病程小于 3个月者 ,3例出现垂体形态变化 ;3～ 1 2个月病程者均出现垂体形态改变 ,仅半数有蝶鞍形态改变 ;病程大于 1 2个月者均出现垂体和蝶鞍形态变化。结论　原发性高颅压患者垂体形态变化早于蝶鞍形态变化 ,垂体形态变化明显者的病程长于垂体形态正常或变化较轻者 ,此表现有助于早期提示和诊断原发性高颅压。     

Assessment of magnetic resonance imaging criteria for the diagnosis of cavernous sinus invasion by pituitary tumors

Cavernous sinus invasion (CSI) by pituitary tumors is associated with subtotal resection and persistent endocrinopathy. The Knosp classification is a magnetic resonance imaging (MRI) tool used to define CSI in the 2017 World Health Organization Classification. However, alternative criteria may have superior diagnostic performance. This study aimed to assess the diagnostic performance of four MRI criteria, using a combination of endoscopy and day 1 MRI as the reference standard for CSI. A cross-sectional study was conducted including patients treated with endoscopic endonasal transsphenoidal surgery for pituitary macroadenomas, recruited from a tertiary pituitary multidisciplinary center in Sydney, Australia between September 2013, and February 2021. The diagnostic performances of four MRI criteria were assessed: the Knosp criteria, percentage encasement of the internal carotid (PEICA), venous compartment obliteration (VCO), and the Fernandez-Miranda classification. Reference CSI was defined using a combination of intraoperative endoscopy and day 1 MRI. A total of 210 cavernous sinuses (105 patients), were analyzed, (51.7 ± 16.3yrs, 43% female), of which 18% had CSI. CSI was best diagnosed by Knosp ≥ 2 (63% sensitivity and 89% specificity), PEICA ≥ 28% (84% sensitivity and 77% specificity) and VCO of ≥ 3 compartments (65% sensitivity and 89% specificity). CSI was unlikely if any of the following signs were present: Knosp < 1, PEICA < 28%, preservation of the medial or superior compartments or sparing of the superior Fernandez-Miranda compartment (negative predictive value 95%, 95%, 94%, 91% and 92% respectively). In conclusion, alternatives to the Knops criteria including PEICA and VCO can aid CSI diagnosis.     

术中磁共振成像在经鼻-蝶入路垂体瘤切除术中的应用研究

目的探讨术中磁共振成像结合神经影像导航系统在经鼻-蝶入路垂体肿瘤切除术中的应用价值。方法采用术中MRI扫描辅助神经导航系统指导经鼻-蝶入路垂体肿瘤切除范围,分析术中MRI对手术过程和患者预后的影响。结果术中MRI扫描系统平均扫描(2.11±0.41)次,所需时间15～20min/次;手术时间共延长47～60min,平均(51.20±0.66)min。38例患者术中MRI共发现11例存在肿瘤残余,其中8例于更新神经导航计划后进一步扩大手术范围全切除肿瘤,3例因肿瘤质地坚韧且与周围解剖结构粘连紧密,仅行部分切除;初次全切除率为71.05%(27/38),在术中MRI导航系统辅助下最终全切除率达92.10%(35/38),提高了21.05%(8/38;χ2=4.290,P=0.018)。术后无一例发生与磁共振检查相关性并发症。结论经鼻-蝶入路垂体肿瘤切除术中应用MRI结合神经导航技术,为指导手术进程及实时判断手术效果提供了客观依据,从而避免了因术中脑组织漂移造成的术前导航偏差,提高肿瘤全切除率。     

伴有和不伴有抑郁的阿尔茨海默病患者在静音Stroop任务下脑功能激活的差异

目的 研究Alzheimer病(AD)与AD伴抑郁患者(depression in Alzheimer's disease,dAD)在注意任务下脑功能激活区的差异.方法 收集临床诊断轻度AD患者20例,符合《精神疾病诊断与统计手册第Ⅳ版》标准(DSM-Ⅳ),其临床痴呆评定量表(CDR)评分1.0,其中9例dAD患者符合国立精神疾病研究院制定的痴呆伴抑郁的诊断标准(NIMH-dAD标准),其康奈尔痴呆中抑郁量表评分(CSDD)＞12.另有10名健康老龄者为对照组.在静音Stroop任务下,计算完成任务的反应时间、错误率和漏报率等行为学指标,同时采集fMRI脑部功能图像,使用SPM2软件分析.结果 dAD、AD与对照组的反应时间(ms)分别为2214.4±107.1、2020.6±558.3、840.0±254.5,dAD与AD组均明显慢于对照组(P＜0.01),且dAD组比AD组更慢(P=0.04).dAD、AD、对照组的错误率分别为:8.3%、6.9%、0.7%;其漏报率分别为:3.6%、2.9%、0,虽然dAD与AD组在错误率(P=0.13)和漏报率(P=0.10)间并无差异,但均明显高于对照组(P＜0.01).对照组在双侧前额背外侧皮质、双侧前扣带回、右侧顶叶和左额下回有明显的激活.AD组仅在左侧顶叶、左前扣带回和右额叶背外侧皮质等有少量激活.dAD组仅在前额皮质和部分右侧前额背外侧皮质处有少量激活.结论 与对照组相比,AD伴有和不伴抑郁的患者均存在异常的脑功能成像,但二者间有着明显的差别,抑郁加重AD的注意功能损害.     

-Aspartate localization in the rat pituitary gland and retina

Rat pituitary gland and retina were probed with anti--aspartate (-Asp) antibody previously prepared in this laboratory [Lee et al., Biochem. Biophys. Res. Commun., 231 (1997) 505–508]. -Asp immunoreactivity (IR) was observed only in the posterior lobe of the pituitary gland of 3-day-old rats, whereas the anterior and posterior lobes were also positive in 3-week and 6-week-old rats, respectively. In the anterior lobe, intense IR was scattered throughout the lobe and the -Asp-positive cells appeared to be prolactin-containing cells or some other very closely related type of cell. In the retina, -Asp IR was observed only in the ganglion cell and nerve fiber region of 3-day-old rats. In contrast, during the transient increase in -Asp levels in 7-day-old rats, -Asp IR was additionally evident in regions where differentiating bipolar cells had begun to make contact with other types of cells. The functional relevance of -Asp localization in these tissues is discussed.     

3.0T MRI多动态增强扫描在垂体微腺瘤检出中的应用

目的探讨3.0T MRI多动态增强扫描在垂体微腺瘤检出中的应用价值。方法使用3.0T MRI对50例垂体微腺瘤患者进行平扫、多动态增强扫描及延迟扫描。结果垂体微腺瘤平扫多只能看到垂体形态的轻微改变,T2WI有时可见到稍长T2信号,多数病灶信号改变不明显。多动态增强扫描增强早期,肿瘤强化程度明显低于正常垂体实质,肿瘤呈稍低信号,境界清楚;中晚期及延时期,肿瘤信号逐渐缓慢增高,部分病灶延时信号高于正常垂体。结论 3.0T MRI多动态增强扫描垂体微腺瘤检出信号具有特征性,可作为临床垂体微腺瘤排查首选。