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.     

磁共振动态增强扫描对诊断垂体微腺瘤的价值

目的评价磁共振动态增强扫描诊断垂体微腺瘤的价值。方法对26例垂体微腺瘤患者的磁共振平扫、动态增强扫描、常规延迟增强扫描影像学资料进行回顾性分析。结果磁共振平扫、动态增强扫描和常规延迟增强扫描微腺瘤检出率分别为53．85％（14／26）,100％（26／26）,和73．08％（19／26）,三种不同的扫描方法微腺瘤检出率有显著差异（P〈0．01）。结论磁共振动态增强扫描能明显提高垂体微腺瘤的捡出率,对垂体微腺瘤的诊断有重要价值。     

护理干预在垂体微腺瘤磁共振动态增强中的应用

目的总结护理干预在垂体微腺瘤3.0T磁共振动态增强扫描中的应用。方法对43例垂体微腺瘤患者进行磁共振动态增强扫描的护理干预,包括检查前评估、心理护理、使用造影剂的护理,检查中和检查后的护理。结果本组43例患者均顺利完成检查,获得满意图像,满足诊断要求。其中42例无不良发应,1例出现荨麻疹,静脉注射地塞米松10mg后症状缓解。本组43例均无造影剂渗漏。结论及时有效的护理干预是保证垂体微腺瘤磁共振动态增强顺利进行的前提。     

垂体微腺瘤的MRI

介绍垂体微腺瘤的常规MRI检查技术,对各种技术的诊断作用进行比较分析。概括和总结了垂体微腺瘤的MRI表现、诊断和鉴别诊断。 直径小于10mm的垂体腺瘤,称垂体微腺瘤。临床上根据患者所出现的垂体功能亢进症状,以及血中有关激素含量水平的增高,一般可以作出初步诊断。CT和MRI能客观地显示病灶。过去认为CT对本病的诊断比MRI优越。近年来随着高均强MR机器的普     

垂体微腺瘤

垂体微腺瘤（ pituitary microadenoma ） 系指起源于腺垂体,直径〈10mm的腺瘤,发病率占颅内肿瘤的10％-15％。按照有无内分泌功能可分为无功能性和功能性腺瘤,前者多在影像学检查或尸检过程中偶然发现;后者以泌乳素瘤多见,发病率为30％-40％,临床主要表现为闭经、泌乳、不孕,生长激素瘤、促肾上腺皮质激素瘤、促性腺激素瘤、促甲状腺激素瘤及混合腺瘤相对少见。     

无功能垂体微腺瘤的诊断和处理

目的 探讨无功能垂体微腺瘤的诊断和手术指征。方法 系统分析１９８７至１９９７年１月经手术和病理证实的１１例无功能垂体微腺瘤的临床资料。结果 ２例闭经,１例恢复正常;４例头痛,３例明显减轻,１例消失;２例视野缺损,１例恢复正常,全部病例术后垂体功能正常。结论 仅不数因有视力视野缺损和垂体功能障碍,大多数病例因怀疑颅内其他病变或体格检查作ＣＴ和ＭＲＩ偶然发现本病。对有垂体相关症状和定期随诊中发现肿瘤增     

垂体微腺瘤所致精神障碍1例

1病例 患者女，19岁。约1年来出现失眠，烦躁，坐立不安，好发脾气，凭空听见同学说话，疑同学跟踪她，想用刀捅死她，有时骂人，兴奋话多，手舞足蹈，不停吐痰，夸大，好接触异性，否认有病。既往史、个人史、家族史无特殊。入院体格检查无阳性发现。精神检查：意识清晰，表情平淡，定向力完整，接触被动，问答不切题，存在言语性幻听，思维散漫，关系妄想，被害妄想，情感不协调，行为异常，注意涣散，智能正常，无自知力。初步诊断精神分裂症未定型。服奎硫平（商品名：启维）最高剂量150mg／d，病情有所缓解。半个月后突然出现失眠，易激惹，头痛。改用奥氮平10mg／d，疗效不佳而停用，后症状自行缓解。     

垂体微泌乳素腺瘤的治疗

泌乳素腺瘤在垂体腺瘤中比例较大，占40％～50％。它是引起生殖功能和性功能障碍的一种常见的病因。生育期女性表现为少经或闭经、不育和溢乳，男性和绝经期女性多为垂体占位的表现（头痛、视力障碍和垂体功能减退）。泌乳素腺瘤绝大多数是微腺瘤，是指直径小于10mm的腺瘤。高泌乳素血症主要原因是泌乳素腺瘤所致，微泌乳素腺瘤也可以引起高泌乳素血症。一旦病人被怀疑患有泌乳素分泌型腺瘤，就应该进行头颅MRI检查，并且通过增强MRI可以描绘肿瘤的大小和肿瘤的侵袭范围。治疗微泌乳素腺瘤的目的在于抑制过多的激素分泌；保护残余的垂体功能；防止肿瘤复发。大多数微泌乳素腺瘤的病人可以通过服用一些显效的药物（如多巴胺激动剂等）治疗，也可以请经验丰富的神经外科医师在显微镜下或内窥镜下对肿瘤进行手术切除。对垂体腺瘤病人选择手术治疗之前，应当综合考虑以下几种因素：肿瘤的大小；肿瘤的生长范围；病人的年龄；不育病人对恢复生育能力的渴望程度；多巴胺激动剂类药物的治疗效果和对此类药物的承受能力等。     

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。     

垂体微腺瘤所致精神障碍1例

垂体微腺瘤以神经及内分泌功能障碍较多见。现报告 1例 ,以妄想和行为障碍为其首发症状。患者女性 ,2 2岁 ,近 3年来不能认真上班 ,不是睡觉就是无故缺勤。不认为是自己过错 ,整天在家无所事事 ,乱交男友 ,与多人发生性关系。既往无重要疾病史 ,家族史阴性。体格检查 :甲状腺 1ｏ 肿大 ,质软 ;其它未见异常。神经系统阴性。精神检查 :神志清 ,接触被动 ,无自知力 ,认为周围人对她不好 ,领导与她过不去 ,情绪易激惹 ,对乱交男友且多次发生性行为认为是正常行为 ,无羞耻感。洛夏测验 :提示受试者情感压抑 ,易冲动 ,在人际环境中适应不良 ,脱离…     

Clinical implications of dynamic MRI for pituitary adenomas: clinical and histologic analysis

To determine the clinical significance of dynamic magnetic resonance imaging (MRI) for pituitary adenomas, we analyzed sequential enhancement patterns of pituitary adenomas and factors contributing to these sequential patterns. Dynamic MRI was performed in 67 patients with pituitary adenomas and compared to conventional imaging. Subjects were classified into four categories according to the sequential enhancement patterns of the adenomas. Factors supposed to correlate with enhancement pattern, such as secreting hormone, tumor size, microscopically examined vascularity and arterial involvement, and intraoperatively observed texture of the adenomas, were examined among the groups. Adenomas inclined to have late enhancement patterns were relatively small compared to those with early patterns. Tumors with very early enhancement patterns were significantly more fibrous than those with the other three patterns. The factors that contribute to sequential enhancement patterns remain unclear. None the less, scrutinizing the dynamic sequential pattern may provide useful information about the probable texture of the tumor.     

垂体瘤质地的相关因素分析及其对治疗的影响

目的分析术前预测垂体瘤质地的相关因素及其对治疗的影响.方法连续搜集60例垂体瘤病人的临床、影像及手术资料,将肿瘤质地分为三种类型：不成形,质地软;成形,质地软;成形、质地韧.结果本组中24例肿瘤不成形、质地软,大多呈膨胀性生长,且大多为类圆形;高功能性腺瘤多属此型.31例肿瘤成形、质地软,多呈浸润性生长,形状不规则.5例成型、质地韧,多为口服溴隐停病人及广泛浸润的巨大腺瘤.三种质地肿瘤的MRI信号变化较大,未发现规律.结论肿瘤质地与肿瘤的生长方式存在内在联系,膨胀性生长者质地多软且不成形,手术可经鼻蝶入路进行.依据MRI不能很好地预测肿瘤质地.     

Normal pituitary volumes in children and adolescents with bipolar disorder: a magnetic resonance imaging study

The volume of the pituitary gland in adults with bipolar disorder has previously been reported to be smaller than that of healthy controls. Such abnormalities would be consistent with the HPA dysfunction reported in this illness. We conducted a study of children and adolescents with bipolar disorder to determine whether size abnormalities in the pituitary gland are already present early in illness course. Magnetic resonance imaging (MRI) morphometric analysis of the pituitary gland was carried out in 16 DSM-IV children and adolescents with bipolar disorder (mean age+/-sd=15.5+/-3.4 years) and 21 healthy controls (mean age+/-sd=16.9+/-3.8 years). Subjects underwent a 1.5 T MRI, with 3-D Spoiled Gradient Recalled (SPGR) acquisition. There was no statistically significant difference between pituitary gland volumes of bipolar patients compared to healthy controls (ANCOVA, age, gender, and ICV as covariates; F=1.77, df=1,32, P=.19). There was a statistically significant direct relationship between age and pituitary gland volume in both groups (r=.59, df=17, P=.007 for healthy controls; r=.61, df=12, P=.008 for bipolar patients). No evidence of size abnormalities in the pituitary gland was found in child and adolescent bipolar patients, contrary to reports involving adult bipolar patients. This suggests that anatomical abnormalities in this structure may develop later in illness course as a result of continued HPA dysfunction.     

Smaller pituitary volume in adult patients with obsessive–compulsive disorder

Aims:  Another structure in the obsessive–compulsive disorder (OCD) circuit may be the pituitary gland because of the fact that limbic–hypothalamic–pituitary–adrenal (LHPA) axis abnormality has been reported in patients with OCD. There has been only one prior study, however, concerning pituitary volumetry, in which the sample was a pediatric group. The purpose of the present study was therefore to investigate this in an adult OCD patient group using magnetic resonance imaging (MRI).
Methods:  Pituitary volume was measured in 23 OCD patients and the same number of healthy control subjects. Volumetric measurements were made on T1-weighted coronal MRI, with 2.40-mm-thick slices, at 1.5 T, and were done blindly.
Results:  A statistically significantly smaller pituitary volume was found in OCD patients compared to healthy controls (age and intracranial volume as covariates). With regard to gender and diagnosis, there was a significant difference in pituitary gland volume ( F  = 4.18, P  < 0.05). In addition, post-hoc analysis indicated near-significant difference in men with OCD as compared with women with OCD ( P  = 0.07) and significant difference between control men and control women ( F  = 10.96, P  < 0.001).
Conclusions:  Taking into consideration that the prior study found decreases in pituitary volume in pediatric patients with OCD as compared with healthy control subjects, future large MRI studies should investigate pituitary size longitudinally, with a careful characterization of hypothalamo-pituitary-adrenal (HPA) function in conjunction with anatomic MRI evaluation.     

术中磁共振影像神经导航辅助经鼻-蝶垂体瘤切除术(附42例分析)

目的探讨术中磁共振影像(iMRI)神经导航技术在经鼻-蝶垂体瘤切除手术中的应用。方法在PoleStar N20 iMRI神经导航系统辅助下施行经鼻-蝶垂体瘤切除术42例。对临床资料、iMRI成像情况及其对手术进程和手术结果的影响等进行分析。结果术中扫描2～5次,平均(2.5±0.87)次。术中扫描发现肿瘤残留13例,其中2例因肿瘤包绕颈内动脉未进一步切除,另11例进一步切除后,达到影像学肿瘤全切除6例,次全切除5例。最终肿瘤的全切除率从69.0%提高到83.3%。无与iMRI相关的并发症。结论经鼻-蝶垂体瘤切除术中应用iMRI神经导航技术,为手术进程的指导及手术结果的实时判断提供了客观依据,从而提高了肿瘤的全切除率。     

垂体脓肿的诊断和治疗(附2例报告及文献复习)

目的探讨垂体脓肿的临床、影像学特点及治疗,提高对垂体脓肿的认识和诊治水平。方法回顾性分析2例垂体脓肿患者的临床表现、影像学特征、诊断和治疗经过,并结合相关文献分析垂体脓肿的诊断和鉴别诊断。结果 2例中年女性患者,主要临床症状为头痛、发热、视觉障碍、多饮多尿、闭经和全身乏力。MRI增强扫描示垂体病灶环形强化伴垂体柄明显强化。例1患者经额下入路清除脓肿,术后使用抗生素和对症治疗,恢复良好。例2患者经鼻蝶入路清除脓肿,术后2个月复发,再次经鼻蝶入路清除脓肿,术后恢复良好。结论垂体脓肿术前诊断困难,早期出现视力和视野改变、尿崩,以及影像学检查出现鞍区环形强化的囊性病灶应考虑垂体脓肿的可能性。早诊断、围手术期合理应用抗生素、及时手术和适当的对症治疗是治疗的关键。     

MRI增强扫描对脑内脱髓鞘假瘤的诊断价值

目的探讨MRI增强扫描对大脑脱髓鞘假瘤(demyelination pseudotumor,DPT)的诊断价值。方法回顾性分析9例经病理或临床证实的大脑DPT患者MRI平扫及增强扫描的表现。结果病灶多发1例,单发8例。MRI平扫显示,病变在T1WI上呈低信号,T2WI上呈高信号,DWI上呈略低、等或略高信号;增强扫描2例病灶内可见斑片状强化,余7例均见垂直于侧脑室的线条状强化。结论 MRI增强扫描对于DPT的诊断具有重要价值。垂直于侧脑室的线条状强化是大脑DPT的典型MRI表现。