单纯生长激素缺乏青少年垂体MRI表现与生长激素激发峰值的相关性研究

目的探讨单纯生长激素缺乏症(isolated growth hormone deficiency,IGHD)青少年的腺垂体各径线值与临床生长激素(growth hormone,GH)激发峰值的关系,为临床诊断提供影像学依据。方法搜集52例临床确诊为IGHD的青少年(7.2～18.3岁)行垂体MRI检查,测量腺垂体各径线并与正常对照组比较;分析其腺垂体各径线及其与GH激发峰值的关系。结果男性患者中,10～<15岁和15～<18.3岁的冠状高径、矢状高径均比正常对照组减小(P<0.05);女性患者中,10～<15岁的冠状高径、矢状高径、矢状前后径均比正常对照组减小(P<0.05)。IGHD患者的腺垂体各径线值在不同性别组和不同年龄组间比较,差异无统计学意义。IGHD患者腺垂体的冠状高径与GH激发峰值呈正相关(r=0.38,P<0.01;r=0.32,P<0.05)。结论 IGHD患者腺垂体各径线值不随性别和年龄而改变,且其腺垂体冠状高径与GH激发峰值呈正相关。     

生长激素缺乏症的患儿垂体MRI改变与临床关系探讨

目的 探讨生长激素缺乏(GHD)矮小症的垂体MRI特点与疾病的关系，了解生长激素(GH)激发峰值对矮小症的垂体诊断及预判，分析垂体发育的影像表现和矮小症的关系。方法 选取我院儿科诊断为CHD矮小症的92例患者儿为观察组，选择同期健康查体的正常儿童65例为对照组，两组一般资料比较差异无统计学意义(P>0.05)。两组受试者行头颅冠状位、矢状位T₁WI序列及轴位T₂WI序列扫描。GH激发试验采用溴吡斯的明与可乐定联合，用药后30、60、90、120 min分别采静脉血1 ml测GH水平，GH峰值≥10μg/L正常，GH峰值5～10μg/L为部分缺乏，GH峰值<5μg/L为完全缺乏。应用SPSS 25.0软件进行统计学分析。结果 观察组92例中MRI垂体形态、信号表现未见异常59例(64.1%),垂体高径为3.0～6.5 mm;垂体形态及信号表现异常33例(35.9%);其中垂体腺瘤4例(4.3%,包括垂体微腺瘤2例);小垂体15例(16.3%);空泡蝶鞍2例(2.2%);垂体柄异常改变(变细、扭曲、饱满)5例(5.4%);垂体肿瘤6例...     

学龄前儿童原发垂体性生长激素缺乏症的MR影像学表现

目的：研究学龄前儿童原发垂体性生长激素缺乏症垂体的MRI特征。方法：回顾分析46例原发垂体性生长激素缺乏症儿童（病例组）垂体的MR影像特征,并与35例同龄健康儿童（对照组）作对照比较。结果：病例组腺垂体平均高度（2.32±0.78）mm,与脑干对比,34例T1WI信号低于脑干,12例信号与脑干相等;44例垂体柄完整连续,矢状面平均宽径（0.89±0.51）mm;2例垂体柄缺如;2例垂体后叶异位于下丘脑漏斗底部的正中隆起。4例合并中枢神经系统畸形。对照组腺垂体高度、垂体柄宽径分别为（3.76±1.21）mm、（1.64±0.59）mm。病例组腺垂体高度、垂体柄矢状宽径均比正常对照组小,差异具有显著性意义。结论：MRI能够清楚的显示原发垂体性生长激素缺乏症垂体的影像学特征,表现为垂体前叶变小,信号低于或等于脑干,垂体柄变细或缺如,大多数垂体后叶位置正常,少数病例后叶异位,以及合并的中枢神经系统畸形。     

正常成人垂体的磁共振测量研究

目的:观察正常垂体形态、测量其大小并探讨其与年龄、性别的变化关系。方法:选取300例非鞍区病变及内分泌症状的正常成年人。按性别、年龄分为5组:20~29岁组,30~39岁组,40~49岁组,50~59岁组及60岁以上组,每组男女各30例,MRI测量矢状位腺体及后叶前后径、高径以及垂体柄前后径;冠状位腺体宽径、高径及垂体柄宽径;比较分析不同性别、年龄段上述各径线MR测量值的变化特点。结果:成人男、女正常垂体冠状高径分别为(4.01±1.08)mm、(3.99±1.37)mm,冠状宽径分别为(9.75±1.63)mm(、10.17±1.59)mm;矢状高径分别为(4.46±1.24)mm(、4.68±1.61)mm;前后径分别为(10.15±1.51)mm(、10.24±0.90)mm;垂体后叶矢状高径分别为(4.01±1.43)mm(、4.59±1.17)mm,前后径分别为(2.01±0.66)mm、(1.98±0.70)mm;垂体柄冠状宽径分别为(1.56±0.21)mm、(1.59±0.21)mm,前后径分别为(1.50±0.23)mm、(1.52±0.22)mm。垂体高径在20~29年龄组最大,有随年龄增大而逐渐减小趋势;垂体宽径及前后垂体后叶及垂体柄各径线有先增大后减小趋势。结论:成人垂体各径线随年龄的变化有先变大后减小趋势。各径线与年龄有一定统计学差异而与性别无明显统计学差异。     

高海拔地区成人正常垂体腺的MRI研究

目的通过MRI研究高海拔地区成人正常垂体腺形态、大小及信号强度,并将之与国内已报道的相关测量数据比较,以确定有无差异性。方法收集120例非鞍区疾病的颅脑MRI资料片测量。采用杨氏的测量方法,分别测量垂体腺的前后径、宽径,矢状位、冠状位高径;垂体后叶的高径、前后径;垂体柄的长径、宽径;同时观察垂体腺的形态及其信号特征。结果垂体腺形态呈平坦型86例（71%）,凹陷型20例（16%）,隆凸型14例（11%）。垂体腺的矢状位高径、前后径分别为5.4±1.3mm、10.3±1.7mm,冠状位的高径、宽径分别为5.0±1.2mm、13.8±2mm;垂体后叶的高径、前后径分别为3.9±1.2mm、2.1±0.5mm;垂体柄的长径和宽径分别为9.6±2.3mm、1.6±0.7mm。结论测得的结果显示高海拔地区垂体腺各径线数据与已报道的国内数据比较,无明显差异。     

正常垂体腺的MRI研究

本文应用MRI观察了103例正常成人(男53例、女50例)垂体腺的形态、大小和信号强度特征。发现11例(10.6％)垂体腺形态呈凸隆型,其余为平坦或凹陷型。96例(93.2％)垂体后叶呈高信号强度,余为等信号强度。测量了垂体腺前后径、宽径、矢状高径和冠状高径,垂体后叶高径和前后径,垂体柄长径和前后径,为诊断垂体腺疾病提供了正常数据。报告了垂体柄和垂体腺的连接位置,讨论了垂体腺形态和信号强度特征等临床诊断意义。     

特发性生长激素缺乏:35例MR所见

特发性生长激素缺乏(IGHD)是指没有肿瘤、手术、放射线照射等明显病因时的生长激素缺乏。作者用MR检查了35例IGHD患者,特别注意观察垂体后叶异位(ectopic neurohypophysis,ENH)、垂体前叶的大小、漏斗不连续或异常及下丘脑损害。如见不到垂体凹后部的高信号结构,而T_1加权象在正中隆起部位发现一高信号结节时则考虑ENH。依视觉判断垂体前叶大、小抑或正常,并将其信号特征和脑灰质对照。扫描用1.5T装置。增强或不增强,采用矢状面600/20(TR/TE)、冠状面500/25序列;也采用矢状面600/20、冠状面600/20和注射造影剂前的冠状面2000/20,     

生长激素-胰岛素样生长因子-1轴与儿童矮小症关系研究

目的探讨生长激素-胰岛素样生长因子-1(GH/IGF-1)轴与儿童矮小症的关系。方法选取自2015年1月至2018年12月于无锡市儿童医院门诊及住院就诊为儿童矮小症的298例患儿为矮小症组,并根据GH峰值分为完全性GH缺乏症组(CGHD组,n=89)、部分性GH缺乏症组(PGHD组,n=87)与特发性矮小症组(ISS组,n=122)。另选取同时期于我院门诊体检的身高正常的100例健康儿童作为正常组。比较各组研究对象的IGF-1、胰岛素样生长因子结合蛋白-3(IGFBP-3)水平,并对矮小症患儿血GH水平与年龄、身高、体质量及IGF-1进行相关性分析,以及矮小症患儿血IGF-1水平与年龄、身高、体质量及IGFBP-3的相关性分析。结果矮小症患儿各组血IGF-1、IGFBP-3水平均显著低于正常组;CGHD组患儿血IGF-1、IGFBP-3水平均显著低于PGHD组、ISS组;组间比较,差异有统计学意义(P<0.05)。PGHD组血IGF-1、IGFBP-3水平虽略低于ISS组,但组间比较,差异无统计学意义(P>0.05)。矮小症患儿血GH水平与年龄、身高、体质量及IGF-1呈正相关(r=0.385,0.486,0.506,0.381),血IGF-1水平与年龄、身高、体质量及IGFBP-3呈正相关(r=0.864,0.925,0.910,0.885)。结论 GH/IGF-1功能轴是对儿童生长发育期关键作用的内分泌轴,其异常是导致儿童矮小的重要原因。     

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.     

中国汉族正常成人垂体的高分辨率MRI研究

目的 研究中国汉族正常成人垂体MRI形态学特征,为建立国人正常标准脑提供垂体形态学数据.方法 采用全国多中心临床研究形式,选取18～70岁978名健康志愿者,并按18～30、31～40、41～50、51～60、61～70岁5个年龄段分为A、B、C、D、E组,行3D磁化强度预备梯度回波序列T1WI,利用3D后处理软件进行MPR,测量垂体体积及各方向径线,以及垂体柄与大脑中线、视交叉及垂体表面夹角.相同性别不同年龄分组的垂体测量值比较采用方差分析,相同组别不同性别垂体测量值的比较采用独立样本t检验分析,垂体分型数据采用x2分析.结果 (1)垂体体积:男性5组垂体体积分别为(1142±290)、(996±223)、(979±178)、(971±174)、(930±189)mm3,女性分别为(1247±210)、(1199±216)、(1108±196)、(1059±212)、(984±177)mm3,在不同年龄组间差异有统计学意义(F值分别为13.811、27.091,P值均<0.01),在男性30岁以后,女性40岁以后垂体体积变小;同年龄组女性垂体体积大于男性(P<0.05);垂体体积与性别、年龄、分型、正中高径、前后径和宽径相关(r=0.646,P<0.01).(2)垂体径线测量统计:垂体正中高径男性各组分别为(6.6±1.5)、(6.0±1.4)、(5.6±1.1)、(5.0±1.2)、(4.9±1.4)mm,女性分别为(7.9±1.6)、(6.4±2.0)、(5.6±1.7)、(5.1±1.7)、(4.4±1.4)姗,不同年龄组间差异有统计学意义(F值分别为24.582、62.978,P值均<0.01),30岁之前女性正中矢状高径大于男性,30岁之后男女垂体正中矢状高径逐渐减小,男性50岁后,女性60岁后降至最低;垂体正中矢状高径与性别、年龄相关(r=0.570,P<0.01).垂体宽径男性各组分别为(14.8±1.8)、(14.7±1.4)、(14.2±1.9)、(14.3±2.1)、(13.8±2.4)mm,女性各组分别为(14.9±1.8)、(15.8±1.7)、(15.5±2.1)、(15.6±2.2)、(14.9±2.1)mm,不同年龄组间差异有统计学意义(F值分别为4.566、4.233,P值均<0.05);垂体宽径与性别、体重、年龄相关(r=0.300,P<0.01).垂体前后径男性各组分别为(11.2±1.2)、(11.8±1.3)、(11.8±1.5)、(12.3±1.8)、(12.2±2.0)mm,女性分别为(11.9±1.3)、(12.5±1.5)、(12.4±1.5)、(12.9±1.6)、(12.7±1.6)mm,不同年龄组间差异有统计学意义(F值分别为7.270、5.903,P值均<0.01),60岁之前男性垂体前后径小于女性(P<0.05),且随后逐渐减小,女性前后径随年龄逐渐减小;垂体正中矢状前后径与性别、年龄相关(r=0.276,P<0.01).(3)垂体柄夹角统计:冠状面重组上垂体柄与垂体表面、视交叉及脑中线之间并无明显偏移,且男女之间差异无统计学意义(P>0.05).(4)垂体分型统计:不同性别年龄组间分型差异有统计学意义(x2值分别为44.212、107.518,P值均<0.01).随年龄增加,隆起型逐渐减少,凹陷型逐渐增加.结论 3D高分辨率MRI能够清晰显示垂体形态,结合3D后处理软件能够准确测量垂体体积及各方向径线以及垂体柄的夹角,为建立标准脑提供科学数据.     

MR imaging in idiopathic growth hormone deficiency.

BACKGROUND AND PURPOSEMR imaging findings of one or more of the following has been suggested to be a sensitive and specific indicator of hypopituitarism: small anterior pituitary gland, attenuated or absent pituitary stalk, and ectopic posterior pituitary. We hypothesized that these MR findings would be common in our group of patients with idiopathic isolated growth hormone deficiency (GHD) or multiple pituitary hormone deficiencies (MPHD) and would be a good indicator of the severity of the hypopituitarism.METHODSMR images were obtained for 35 patients with idiopathic GHD (20 with isolated GHD and 15 with MPHD; age range, 2 to 17 years) and analyzed to define one or more of the following triad of abnormalities: 1) small/absent anterior pituitary, 2) truncated/absent pituitary stalk, and 3) ectopic posterior pituitary, as well as for any other associated anomalies. The findings were correlated with the clinical and biochemical presentation.RESULTSPituitary abnormalities were common in both groups (80% with isolated GHD, 93% with MPHD). We found a high frequency of midline CNS malformations, including optic nerve hypoplasia (9%), Chiari type I malformations (20%), and medial deviation of the carotid arteries (37%). Breech delivery, neonatal hypoglycemia, jaundice, micropenis, or single central incisor occurred equally with both isolated GHD and MPHD. In patients whose peak growth hormone level was less than 3 microg/L (n = 19), 90% had the MR triad, compared with 390% of those with growth hormone levels 3 microg/L or greater or less than 8 microg/L (n = 13) (P <.01). Almost all (92%) of those with ectopic posterior pituitary had anterior pituitary heights less than -2 SD for age.CONCLUSIONMR abnormalities were common in children with both isolated GHD and MPHD and were closely associated with peak growth hormone levels less than 3 microg/L. The presence of other CNS and clinical findings (eg, single central incisor and micropenis) supports the theory of an embryologic defect as the cause of the pituitary abnormalities.     

MR findings in hereditary isolated growth hormone deficiency.

PURPOSETo describe the MR characteristics by which patients with hereditary isolated growth hormone deficiency (GHD) can be distinguished from patients with other types of GHD.METHODSA total of 51 patients with GHD were examined prospectively with MR imaging. On the basis of familial occurrence of GHD and genetic analysis, 10 patients met the criteria for hereditary deficiency. In each case, the height of the pituitary gland, the presence and location of the posterior neurohypophysis, and the completeness of the stalk were recorded. The findings in the hereditary group were compared with those in the rest of the patients.RESULTSIn all 10 patients with hereditary GHD, the adenohypophysis, the neurohypophysis, and the stalk were normal. Of the other 41 patients, the height of the gland was normal in three (7%), the neurohypophysis was abnormal in all, and the stalk was truncated in all but two patients (95%).CONCLUSIONSThe subgroup of patients with hereditary GHD exhibited an anatomically normal pituitary-hypothalamic region. This is in contrast to the majority of patients with idiopathic GHD. MR imaging can contribute to the classification of patients with GHD.     

Improved left ventricular function after growth hormone replacement in patients with hypopituitarism: Assessment with radionuclide angiography

Prolonged growth hormone deficiency (GHD) leads to marked cardiac dysfunction; however, whether reversal of this abnormality may be achieved after specific replacement therapy has not yet been completely clarified. Fourteen patients with childhood-onset GHD (nine men and five women, mean age 27±4 years) and 12 normal control subjects underwent equilibrium radionuclide angiography under control conditions at rest. Patients with GHD were also studied 6 months after recombinant human (rh) GH treatment (0.05 IU/kg per day). Normal control subjects and patients with GHD did not differ with respect to age, gender and heart rate. In contrast, left ventricular ejection fraction (53%±9% vs 66%±6%,P <0.001), stroke volume index (41±11 vs 51±8 ml/m²,P <0.01) and cardiac index (2.8±0.6 vs 3.±0.51/min/m²,P <0.001) were significantly lower in GHD patients than in normal control subjects. None of the GHD patients showed adverse or side-effects during rhGH therapy; thus none required a reduction in GH dose during the treatment period. Heart rate and arterial blood pressure were not significantly modified by rhGH treatment. After 6 months of rhGH therapy a significant improvement in left ventricular ejection fraction (from 53%±9% to 59%±9%,P <0.01), stroke volume index (from 41±11 to 47±13 ml/m²,P <0.05) and cardiac index (from 2.8±0.6 to 3.3±0.8 1/min/m²,P <0.01) was observed in GHD patients. In conclusion, prolonged lack of GH leads to impaired left ventricular function at rest. Reversal of this abnormality may be observed after 6 months of specific replacement therapy in patients with childhood-onset GHD.     

垂体微腺瘤MRI和CT对照研究

目的：探讨垂体内低信号灶，垂体高度，上缘形状，鞍底骨质凹陷和垂体柄移位对垂体微腺瘤的ＭＲＩ诊断价值；比较ＭＲＩ和ＣＴ在显示上述征像上的能力。材料和方法：对５０例正常对照组垂体腺和４１例病理证实的垂体微腺瘤术前ＭＲＩ进行对比观察，并对其中２０例微腺瘤进行ＭＲＩ和ＣＴ特征对照研究。结果：对照组与腺瘤组相比垂体腺增高，上缘凸起，内有低信号灶的发生率有显著差异（ｐ＜０．０１），鞍底凹陷侵独发生率也有显著差别（ｐ＜０．０５），垂体柄向腺瘤对侧移位发生率无显著差别（ｐ＜０．１）。在判断垂体微腺瘤的位置及大小（５．１±２．０／５．２±１．９ｍｍ）、鞍隔上抬（１６／１５）、垂体柄偏位（１０／９）以及垂体增大（１７／１６）上，ＭＲＩ稍优于ＣＴ（ｐ＞０．２５）。明确鞍底骨质侵蚀ＣＴ明显优于ＭＲＩ（ｐ＜０．０５）。结论：增大垂体腺内出现低信号灶，伴上缘凸起和鞍底凹陷侵蚀为ＭＲＩ诊断微腺瘤最可靠征像；ＭＲＩ在显示上述征像（鞍底骨质侵蚀除外）上优于ＣＴ。     

Variant sella morphology and pituitary gland height in adult patients with Chiari II malformation: potential pitfall in MRI evaluation

PurposeTo systematically evaluate the sella morphology and pituitary gland height on brain MRI of Chiari II malformation (C2M) patients to understand the observed high incidence of apparent enlargement of the pituitary gland.MethodsBrain MRIs of C2M patients at a single tertiary care adult institution were retrospectively reviewed. We also evaluated two age and gender-matched control groups-patients with normal brain MRI (C1 group) and chronic ventricular shunts (C2 group). The heights of tuberculum sella, dorsum sella, and pituitary gland were measured and compared. The presence or absence of dural thickening was noted.Results21 patients were included in each group. In C2M group, a pituitary adenoma was suggested on 24% of the MRIs. The dorsum sella was significantly smaller in the C2M group (4.8 mm) compared to both the C1 group (7.4 mm, p < 0.001) and the C2 group (7.1 mm, p < 0.001). The pituitary gland was also larger in the cranial-caudal dimension in C2M group (8.6 mm) as compared to both the C1 group (6.6 mm, p < 0.01) and the C2 group (6.0 mm, p < 0.001). One C2M patient with a pituitary gland<10 mm was suggested to have a pituitary adenoma on outside MRI, although a normal pituitary gland was seen on pathology.ConclusionC2M patients have shallow sella which can accentuate the pituitary gland height. The mean pituitary height was larger in C2M patients, but no functional pituitary pathology was present. It is important to consider sella morphology when evaluating the pituitary gland of C2M patients to avoid unnecessary medical and surgical interventions.     

MRI of pituitary adenomas in acromegaly

Adenomas causing acromegaly represent at least a quarter of pituitary adenomas. We studied 12 patients presenting with active acromegaly due to a pituitary adenoma with a 1.5 T superconductive MRI unit. All had T1-weighted sagittal and coronal sections before and after Gd-DTPA; six had coronal T2-weighted images. Surgical correlation was obtained in seven patients. Histologically, there were eight growth hormone (GH)-secreting and three mixed [GH and prolactin (PRL) secreting] adenomas, and one secreting GH, PRL and follicle-stimulating hormone. Macroadenomas (10) were more frequent than microadenomas (2). No correlation was found between serum GH and tumour size. There were nine adenomas in the lateral part of the pituitary gland; seven showed lateral or infrasellar invasion. Homogeneous, isointense signal on T1- and T2-weighted images was observed in six cases. Heterogeneous adenomas had cystic or necrotic components. Received: 29 April 1996 Accepted: 8 August 1996     

Decreased pituitary gland height after radiation treatment to the hypothalamic-pituitary axis evaluated by MR.

PURPOSETo evaluate treatment-related changes in pituitary gland morphology after childhood cancer and to compare these findings with growth data.METHODSForty-three survivors of childhood cancer were evaluated by cranial MR imaging. Twenty-nine of the patients had received radiation therapy to the hypothalamic-pituitary axis with doses of 10 to 46 Gy. The height of the pituitary gland was measured from midline sagittal images and compared with age- and sex-matched controls. Pituitary gland heights were compared with body height standard deviation scores in patients.RESULTSThe patients who had received radiation therapy to the hypothalamic-pituitary axis had significantly smaller pituitary glands than patients in the nonirradiated group or their age- and sex-matched controls (mean, 3.5 mm versus 5.9 and 5.8 mm, respectively). They were also significantly shorter than patients in the nonirradiated group.CONCLUSIONRadiation therapy to the hypothalamic-pituitary area may lead to poor growth of the pituitary gland and short stature.     

重组人生长激素治疗重症烧伤患者的临床效果观察

目的：探究重组人生长激素（ rhGH）在治疗重症烧伤患者时的临床疗效。方法笔者将2011年12月～2013年12月收治的84例重症烧伤患者分为实验组和对照组;实验组42例,治疗过程中给予重组人生长激素;对照组42例,给予生理盐水安慰剂。对所有患者术前、术后生长激素、血糖、胰岛素、胰高血糖素,以及前蛋白、血浆总蛋白、患者住院时间等进行统计分析。结果在使用rhGH 3d后,实验组的血生长激素浓度开始升高,且数值高于对照组,两者差异具有统计学意义（ P＜0．05）;从第10天开始,患者血清中前白蛋白（ PA）、血浆总蛋白（ Tb）差异逐渐明显,同时实验组患者住院时间也低于对照组,差异具有统计学意义（ P＜0．05）;此外,两组患者体内的皮质醇和胰高血糖素在整个观察期间无明显差异,差异无统计学意义（ P＞0．05）。结论 rhGH在治疗重症烧伤患者时具有较好的临床疗效,能降低患者不良反应的发生率,减少住院时间,值得临床运用。