侵袭性垂体腺瘤的MRI表现与MMP-9表达的相关性

目的研究侵袭性垂体腺瘤侵袭鞍底、鞍旁的不同MRI表现与MMP-9表达水平的相关性。资料与方法经手术、病理证实的垂体腺瘤90例,免疫组织化学染色,评价MMP-9的表达水平与肿瘤对鞍底及鞍旁的不同侵犯程度的MRI表现之间的关系。结果手术证实侵袭性垂体腺瘤59例。蝶窦腔内见肿瘤者30例（58.8%）,对诊断肿瘤侵袭性的敏感性为59%,特异性为100%,阳性预测值为100%,阴性预测值为65%。受侵犯的海绵窦中有95%（57/60）超过该侧颈内动脉外侧壁连线,对诊断肿瘤侵袭性的敏感性为95%,特异性为100%,阳性预测值为100%,阴性预测值为98%。垂体腺瘤包绕范围〉2/3者37侧,对诊断相应侧别海绵窦受侵袭的敏感性为62%,特异性为100%,阳性预测值100%,阴性预测值84%。侵犯海绵窦或鞍底的垂体腺瘤的MMP-9表达水平均高于未侵犯海绵窦或鞍底的垂体腺瘤。结论将鞍底破坏,窦腔内直接可见肿瘤组织作为鞍底受侵袭的MRI标准,将肿瘤向两侧超过颈内动脉海绵窦段和床突段外侧壁连线,或肿瘤包绕颈内动脉范围〉2/3至完全包绕作为海绵窦受侵袭的MRI标准。     

MR imaging features of thyrotropin-secreting pituitary adenomas at initial presentation

OBJECTIVE: We report the MR imaging characteristics of thyrotropin-producing pituitary adenomas at their initial presentation and also report the role of MR imaging in predicting surgical outcome in these rare tumors. MATERIALS AND METHODS: We reviewed the records and MR images of 21 patients with thyrotropin-producing pituitary adenomas from 1984 to 1999. The imaging features of these tumors were examined, including enhancing characteristics and tumor volumes. A staging system of tumor invasion was designed by grading cavernous and sphenoid sinus invasion and suprasellar extension. A cumulative invasion score was then used as a predictor of short-term surgical outcome. RESULTS: Twenty patients had macroadenomas, and one patient had a microadenoma. In 17 of 21 patients, the thyrotropin-producing pituitary adenoma was clearly visualized as a hypoenhancing mass compressing the normal pituitary gland. Conversely, in four patients, the pituitary gland was not discernible because of complete distortion by the adenoma. Thyrotropin-producing pituitary adenomas were large and showed a tendency to invade surrounding structures. Tumor volume ranged from 0.42 to 94.2 cm(3) (mean +/- SD, 16.0 +/- 17.8 cm(3)). The mean score of tumor invasion was 4.77 +/- 2.06 of a maximal possible value of 9.0. A high staging score was found to be predictive of an unfavorable response to surgery. CONCLUSION: Thyrotropin-producing pituitary adenomas are usually large tumors at initial presentation with hypoenhancing features compared with normal pituitary tissue; they tend to be invasive. Greater amounts of invasion correlate with incomplete surgical removal of the tumor and continued hormonal secretion.     

侵袭性垂体腺瘤的MRI诊断价值

目的 研究侵袭性垂体腺瘤的MRI影像特征。方法 回顾分析32例经手术及病理证实的侵袭性垂体腺瘤的MRI表现。结果 侵袭性垂体腺瘤的MRI影像学表现:①肿瘤超过颈内动脉(ICA)外侧壁切线;②海绵窦外侧静脉丛间隙消失;③3个或3个以上海绵窦静脉丛间隙消失;④窦内颈内动脉(ICA)被包绕50%以上,甚至被完全包裹。结论 MRI以无创伤、无骨伪影、软组织分辨率高、解剖背景清楚及三维成像等优点,是术前诊断侵袭性垂体腺瘤最主要和最重要的检查手段。     

MR imaging of cavernous sinus involvement by pituitary adenomas

The ability of high-resolution MR imaging (1.5 T) to detect invasion of the cavernous sinuses by pituitary adenoma was determined through a retrospective review of 74 patients. These patients were divided into three groups: 25 normal subjects, 24 subjects with invasive pituitary adenomas, and 25 subjects with noninvasive pituitary adenomas. A fourth group of 30 patients, who subsequently underwent surgery for pituitary adenoma, was evaluated prospectively by MR for the presence or absence of cavernous sinus invasion. Several features were analyzed: (1) the detectability of the medial and lateral dural margins of the cavernous sinus (2) the size and variation in intensity of compartments within the cavernous sinus (3) the relationship of endocrine function to the surgical and MR appearance of the cavernous sinus and (4) carotid artery displacement or encasement by tumor. The normal cavernous sinuses were usually symmetric, but their sizes varied. The lateral dural margin of the cavernous sinus was always recognized on MR as a linear, discrete, low-intensity area. The medial dural margin (pituitary capsule) was seen on MR in only two of the 25 normal patients. In all 24 patients with cavernous sinus invasion involvement was unilateral and was most common with laterally positioned prolactin or adrenocorticotropic hormone secretory adenomas. Invasion of the cavernous sinus was suspected by MR in only two of the 13 invasive microadenomas and was questionable in three. In 10 of the 11 macroadenomas with surgically proved dural invasion, MR demonstrated an asymmetric increase in size and intensity of the superior and inferior cavernous sinus compartments. Noninvasive macroadenomas compressed and displaced the cavernous sinus bilaterally. The prospective MR evaluation of 30 patients undergoing surgery for pituitary tumor revealed a sensitivity for predicting cavernous sinus invasion of 55%, a specificity of 85.7%, a positive predictive value of 62.5%, and a negative predictive value of 81.8%. No feature permitted certain distinction between invasive and noninvasive microadenomas, as the medial dural wall of the cavernous sinus could not be reliably identified. The most specific sign of cavernous sinus invasion was carotid artery encasement.     

侵袭性垂体腺瘤:MRI与术中对照研究(附35例回顾分析)

目的:探讨MRI推断侵袭性垂体瘤质地、侵袭性的价值。方法:35例行MR检查侵袭性垂体瘤病人,测量T1WI及T2WI肿瘤信号与脑白质信号的比值和强化前后肿瘤T1WI信号强度比值,与其术中所见及术后病理对照,术中据肿瘤硬度分为质软、中等、硬;术后瘤体送检,结果进行统计学分析。结果:T2WI瘤体与白质信号比值与瘤体质地有明显相关性(P<0.01);MRI所示垂体瘤海绵窦及鞍周侵袭与术中及术后病理总符合率达85.3%。结论:MRI可以在术前准确预测侵袭性垂体瘤的质地、侵袭性。     

Pre-operative MRI predictors of hormonal remission status post pituitary adenoma resection

IntroductionContrast-enhanced (CE) Constructive Interference in Steady State (CISS) and Volumetric Interpolated Breath-hold Examination (VIBE) are MRI sequences used to improve the detection of pituitary adenomas and adjacent cranial nerves. The purpose of this study was to assess image quality and identify imaging predictors of postoperative hormonal remission of functioning pituitary adenomas using CE-T1 weighted image (WI), T2WI, CE-CISS, and CE-VIBE MRI sequences.Materials and methodsPatients with pre-operative CE-T1WI, T2WI, CE-CISS, and CE-VIBE pituitary MRI sequences were included in this institutional retrospective review. Three raters independently reviewed randomized sequences in a blinded fashion for adenoma characteristics and parasellar invasion. Subgroup analysis of hormonal remission was performed.ResultsA total of 34 functioning pituitary adenoma patients were included (average age 39.3 ± 12.2; female n = 27), 30 of which had post-operative hormonal remission (n = 34; 88.2%). Compared to CE-T1WI, CE-CISS has significantly higher number of sequences rated “good” image quality (p = 0.02). Hormone remission was associated with decreased degrees of pre-operative internal carotid artery (ICA) contact and Knosp score (p ≤ 0.02) on all sequences except for Knosp score on T2WI. On receiver operating characteristic analysis, the area under curve for differentiating endocrine remission ranged from 0.88 to 0.92 for Knosp score and 0.85–0.93 for ICA contact, depending on sequence.ConclusionExtent of pituitary adenoma cavernous sinus invasion as measured by degrees of ICA contact and Knosp score is associated with postoperative endocrine outcomes. Given improved image quality, inclusion of CE-CISS may be helpful for pre-surgical planning.     

常规MRI联合DWI在鉴别侵袭性与非侵袭性垂体瘤中的价值

目的：探讨常规MRI联合扩散加权成像（DWI）对鉴别侵袭性和非侵袭性垂体瘤的价值。方法：回顾性分析35例经手术病理证实的垂体瘤患者的MRI及DWI影像资料,将非侵袭性（6例）和侵袭性垂体瘤（29例）分成A组和B组,选用Fisher检验对两组某些MRI表现的例数进行比较,而对肿瘤大小和ADC值比较用t检验。结果：肿瘤的发生部位、周围侵犯、肿瘤形状、大小及ADC值等MRI特点的比较,A组与B组差异均具有统计学意义（P〈0.005）,当应用ADC值0.903×10-3mm2/s作为鉴别两组肿瘤的指标时,诊断符合率达97%。结论：常规MRI联合DWI（包括ADC值）对鉴别诊断侵袭性与非侵袭性垂体瘤及其邻近结构的受累均有重要价值。     

垂体腺瘤中FRα的表达与临床意义

目的检测垂体腺瘤中叶酸受体α（FRα）的表达情况,探讨FRα与垂体腺瘤相关临床指标的关系。方法运用冰冻切片免疫组化方法,检测124例垂体腺瘤中FRα的表达情况,分析其与患者性别、年龄、肿瘤径线、肿瘤侵袭性的关系。结果 FRα在NF腺瘤中的阳性率为73.8%（31/42）,在PRL腺瘤中的阳性率为9.7%（3/31）,在GH腺瘤中的阳性率为6.7%（2/30）,在ACTH腺瘤中的阳性率为9.5%（2/21）,FRα在NF腺瘤中的表达水平明显高于在其他病理类型垂体腺瘤中的表达（P〈0.05）。在垂体NF腺瘤中,FRα的表达与肿瘤的侵袭性有关（P〈0.05）,与性别、年龄、肿瘤大小无明显关系（P＞0.05）。在其他三种垂体腺瘤中,FRα与上述指标无明显关系。结论 FRα在垂体NF腺瘤中高表达,在其他病理类型的垂体腺瘤中低表达;FRα与垂体NF腺瘤的侵袭性相关。     

尿激酶型纤溶酶原激活物在侵袭性垂体腺瘤中的表达及意义

 目的 探讨尿激酶型纤溶酶原激活物(uPA)在侵袭性垂体腺瘤和非侵袭性垂体腺瘤中的表达及其临床意义.方法 应用免疫组化法检测26例侵袭性垂体腺瘤和20例非侵袭性垂体腺瘤中uPA的表达,并结合临床资料分析.结果 uPA在侵袭性垂体腺瘤的表达明显高于在非侵袭性垂体腺瘤中的表达,uPA的表达水平与垂体腺瘤的侵袭性呈正相关.结论 uPA与垂体腺瘤侵袭性生长及复发相关,是影响预后的重要因素之一.     

Use of 201Tl SPECT for evaluation of biologic behavior in pituitary adenomas.

Although pituitary adenomas are regarded as benign tumors, some of them behave aggressively with malignant behavior of invasion and metastasis. Prediction of such biologic behavior in a tumor is important for therapeutic planning. The purpose of this study was to assess the usefulness of 201Tl chloride SPECT (201Tl SPECT) for evaluation of biologic behavior in pituitary adenomas. METHODS: 201Tl SPECT was performed on 22 patients with pituitary adenomas. 201Tl uptake indices were calculated, and the results were compared between invasive pituitary adenomas and noninvasive pituitary adenomas. Correlation of the 201Tl uptake index and the MIB1 monoclonal antibody labeling index (MIB1 labeling index) of the tumors was also estimated. RESULTS: In comparison with noninvasive pituitary adenomas, invasive pituitary adenomas exhibited significantly higher 201Tl uptake indices on both the early and the delayed images (P = 0.0010 and 0.0019, respectively). A significant correlation was found between the 201Tl uptake index on the delayed image and the MIB1 labeling index (P = 0.0107). CONCLUSION: 201Tl SPECT can be useful for detecting biologic aggressiveness in pituitary adenomas.     

垂体腺瘤MRI强化特征与VEGF、bFGF mRNA表达的关系

目的探讨垂体腺瘤T1W I动态增强及常规MR I表现与VEGF和bFGF mRNA表达的相关性。方法对30例垂体腺瘤患者术前行快速梯度回波序列(Turbo-FLASH)T1W I动态增强和常规MR I,术后应用逆转录PCR(RT-PCR)方法检测垂体腺瘤组织标本中VEGF和bFGF mRNA的表达,分析动态增强及常规MR I表现与VEGF和bFGF mRNA表达之间的关系。结果垂体腺瘤动态增强时间-信号强度曲线(SI-TC)不同类型之间的VEGF、bFGF mRNA值有显著性差异(Ρ<0.05)。VEGF和bFGF与SSm ax呈显著正相关(Ρ<0.05)。肿瘤强化率不同程度间的VEGF、bFGF值有显著性差异(Ρ<0.05)。结论垂体腺瘤MR I强化特征可一定程度反映VEGF和bFGF mRNA的表达。     

VEGF/PTEN及下游信号通路在侵袭性垂体瘤中的表达及其临床意义

 目的 探讨侵袭性垂体瘤中血管内皮细胞生长因子(vascular endothelial growth factor, VEGF)与人第10号染色体缺失的磷酸酶 (gene of phosphate and tension homology deleted on chromsome ten, PTEN)表达水平及其下游信号通路的变化的临床意义。方法 收集医院神经外科手术后垂体瘤标本62例(侵袭组32例,非侵袭组30例)和60例正常垂体组织标本(对照组)。通过实时定量PCR和蛋白质印迹法检测比较VEGF、PTEN、磷酸化丝氨酸/苏氨酸激酶(phosphate-Serine/threonine Kinase, p-Akt)、磷酸化丝裂原活化蛋白激酶(phosphate-mitogen-activated protein kinase, p-MAPK)在垂体瘤和正常垂体组织之间的表达差异。结果 垂体瘤标本中VEGF的表达水平显著高于对照组(P<0.05),在侵袭组(3.61±0.16)中的表达高于非侵袭组(2.06±0.13),差异有统计学意义(t=10.60, P<0.05),而PTEN在垂体瘤标本中的表达显著低于对照组(P<0.05),尤其在侵袭组(0.42±0.10)中的表达显著降低(t=6.31, P<0.05)。垂体瘤标本中p-Akt和p-MAPK水平显著高于对照组(P<0.05),且侵袭组(p-Akt 3.90±0.14; p-MAPK 2.52±0.11)明显高于非侵袭组(p-Akt 2.27±0.11; p-MAPK 1.89±0.05)(p-Akt,t=12.95, P<0.05; p-MAPK t=7.29, P<0.05)。结论 侵袭性垂体瘤中VEGF、p-Akt及p-MAPK水平明显增高,而PTEN表达水平显著降低,提示上述变化可能与垂体瘤的侵袭性相关,其可能为诊断并治疗侵袭性垂体瘤靶点的选择提供新方向。     

Endocrinological and MRI features of pituitary adenomas with marked xanthogranulomatous reaction

Introduction

The study aims to describe the endocrinological and magnetic resonance imaging (MRI) features of the rarely reported xanthogranulomas associated with pituitary adenoma.

Methods

Of 231 consecutive pituitary adenomas treated surgically, those with xanthogranulomatous reaction on histology were reviewed.

Results

Five patients (2.2%) had an adenoma with marked xanthogranulomatous reaction. They were all nonfunctioning macroadenomas and presented with anterior pituitary insufficiencies. On MRI, all adenomas showed mixed signal intensities on T1- and T2-weighted images with heterogeneous gadolinium enhancement, reflecting their complex histological features: Cholesterol clefts typically showed T1 high- and T2 low-signal intensities. Preoperative diagnosis was difficult in a case predominantly featuring xanthogranuloma. Although none of them had episodes of pituitary apoplexy, hemosiderin deposits and cysts with xanthochromic-like fluid were observed in five and four cases, respectively.

Conclusions

Xanthogranulomatous reaction may develop in macroadenomas, probably triggered by hemorrhagic processes despite no apoplectic episodes. They typically exhibit complex mixed signal intensity on MRI, particularly T1 high- and T2 low-signal intensities, and patients present with pituitary dysfunction.     

中央颅底区域病变的MRI诊断与鉴别诊断

目的 研究中央颅底区域肿瘤的ＭＲＩ表现,探讨其诊断与鉴别诊断要点,材料与方法 分析６５例经病理证实的肿瘤（如鼻咽癌、血管纤维瘤、脊索瘤、侵袭性垂体瘤等）的ＭＲＩ表现,重点病变的信号、部位和健儿特征。结果 血管纤维瘤、黑色素瘤等少数肿瘤的ＭＲ信号具有特征性,肿瘤的中心部位（如血管纤维瘤、脊索瘤、垂体瘤及邻近肿瘤的侵犯）对定性诊断有所帮助,当病变破坏广泛时鉴别比较困难。结论 ＭＲＩ可充分显示肿瘤的范围     

侵袭性垂体瘤继发脓肿的MRI诊断(附3例报告)

目的探讨MRI对侵袭性垂体瘤继发脓肿的误诊原因：方法复习3例侵袭性垂体瘤继发脓肿的MRI表现，全部经临床和病理证实。结果本组误诊病例中，1例侵袭性垂体瘤继发脓肿酷似囊肿；2例酷似动脉瘤。结论侵袭性垂体瘤合并感染时，其影像表现多种多样，应根据各种征象进行综合分析，以避免误诊。     

垂体肿瘤转化基因在人垂体腺瘤中的表达

 目的用反转录-PCR方法定量研究垂体肿瘤转化基因(Pituitary tumortransforming gene,PTTG)mRNA在不同类型的垂体腺瘤中的表达,明确:(1)在不同类型的垂体腺瘤中,PTTG mRNA的表达是否存在细胞特异性,其表达量是否有差别;(2)PTTG mRNA的表达量与肿瘤分级分期的关系,从而进一步探讨PTTG在垂体腺瘤发生发展过程中的作用.方法 20例垂体腺瘤,手术中取出,迅速冻于液氮中保存.根据血清激素水平和临床表现确定腺瘤类型.根据影像学和术中所见对肿瘤分级和分期.用异硫氢酸胍一步法提取垂体腺瘤组织总RNA,用RT-PCR方法检测PTTG mRNA在各组垂体腺瘤组织中的表达.结果 20例垂体腺瘤患者,泌乳素(Prolactin,PRL)腺瘤6例,生长激素(Growth hormone,GH)腺瘤6例,无功能瘤8例.PTTG mRNA在所有PRL瘤、GH瘤和无功能瘤中有表达.PTTG mRNA在PRL、GH和无功能瘤中的表达量无明显差别.PTTG在Ⅱ级、Ⅲ级以及Ⅳ级垂体腺瘤组织中的表达量呈逐渐升高的趋势,组间比较有明显差别(P＜0.01),PTTG在A期、B期以及C期腺瘤的表达量呈逐渐升高的趋势,组间比较有明显差别(P＜0.01).结论 PTTG mRNA在PRL瘤、GH瘤以及无功能瘤中均有表达,PTTG mRNA表达量随着垂体肿瘤浸润程度的增高而升高,PTTG在垂体肿瘤发生和发展中起重要的作用.     

11C-methionine PET for the diagnosis and management of recurrent pituitary adenomas

Purpose The detection of recurrent pituitary adenoma by magnetic resonance imaging (MRI) is rendered uncertain by the tissue remodelling that follows surgery or radiotherapy. We aimed to evaluate the contribution of PET with ¹¹C-methionine (MET-PET) in the detection and management of recurrent pituitary adenoma.Methods Thirty-three patients with pituitary adenoma were evaluated postoperatively by MET-PET, either because of biological evidence of active residual tumour or because of MRI demonstration of non-functional adenoma growth. We studied 24 secreting adenomas and nine non-functional adenomas.Results In 30 patients, MET-PET detected abnormally hypermetabolic tissue. In 14 out of these, MRI did not differentiate between residual tumour and scar formation. In nine of these 14 cases, major therapeutic decisions were undertaken (radiosurgery and surgery). In another group of 16 patients, both MET-PET and MRI detected abnormal tissue. In one case, neither MRI nor MET-PET detected adenomatous tissue. Finally, abnormal tissue was detected in two patients on MRI solely. In these two cases, failure of MET-PET to reveal the adenoma was attributable to concomitant inhibitory therapy. The sensitivity of MET-PET and MRI varied as a function of the tumour type: all non-functional adenomas were localised by both modalities, while MET-PET detected all adrenocorticotropic hormone-secreting adenomas whereas MRI depicted only one of these eight lesions. Fifteen out of 17 patients treated by radiosurgery showed clinical improvement after treatment.Conclusion We suggest that MET-PET is a sensitive technique complementary to MRI for the detection of residual or recurrent pituitary adenomas. It should gain a place in the efficient management of these tumours.     

Cavernous sinus lesions

The cavernous sinus is a complex structure susceptible to a wide variety of vascular, neoplastic and inflammatory pathologies. Vascular pathologies include ICA aneurysms, carotid-cavernous fistulas, cavernous sinus thrombosis, and cavernous hemangioma. Neoplasms that involve the cavernous sinus include pituitary adenoma, meningioma, schwannoma, lymphoma, perineural tumor spread, metastases, and direct tumor invasion. Infectious and inflammatory diseases include Tolosa-Hunt syndrome, sarcoidosis, granulomatosis with polyangiitis, IgG-4 related disease and invasive fungal infections. In this article, we review the clinical and imaging findings of a number of pathologies involving the cavernous sinus, focusing on key features that can narrow the differential diagnosis and, in some cases, support a particular diagnosis.     

肝门部胆管癌MR表现与病理、肿瘤血管生成的相关性研究

目的 探讨肝门部胆管癌MRI表现与病理、肿瘤血管生成之间的相关性.方法 对28例肝门部胆管癌患者术前行MR扫描,分析MRI形态学特征、动态增强表现;术后标本行免疫组化染色测定病灶微血管密度（MVD）、血管内皮生长因子（VEGF）的表达情况,并分析其与MRI表现之间的相关性.结果 侵袭转移（16例）组、病灶内胆管扩张（8例）组的MVD、VEGF表达明显高于无侵袭转移组、无病灶内胆管扩张组,且均具有统计学意义（P＜0.05）.肿瘤生长方式的分型与MVD、VEGF表达无明显相关性（P＞0.05）.MRI动态增强扫描中,不同强化形式组间的MVD值存在统计学差异（P＜0.05）,ASI（早期信号强度增强率）与MVD呈明显正相关,与VEGF的表达亦有相关性.结论 肝门部胆管癌MRI表现与病理、肿瘤血管生成之间存在一定相关性,可根据其MRI表现对癌灶的生物学行为和预后进行评估.     

The value of paramagnetic contrast agent gadolinium-DTPA in the diagnosis of pituitary adenomas

Summary The purpose of this study was to assess the role of MR imaging and the paramagnetic contrast agent Gadolinium-DTPA(Gd-DTPA) in the diagnosis of pituitary macroadenomas. 44 macroadenomas were examined with MRI before and after intravenous application of Gd-DTPA. Gd-DTPA produced excellent enhancement of solid adenoma. The best contrast between adenoma and surrounding structures could be gained on post-Gd T1-weighted images. Post-Gd images were equivalent to pre-Gd images in the evaluation of supra-and infrasellar extensions of macroadenomas. Post-Gd images had advantages in the evaluation of cavernous sinus invasion by adenoma. The difference in degree of contrast enhancement between adenoma and cavernous sinus facilitated the exact evaluation of lateral extension by adenoma in 18 cases. Almost equal degree of enhancement of both structures impaired tumor-sinus contrast in 2 cases. In the other 24 cases the tumor filled the cavernous sinus completely. It is our opinion that Gd-DTPA can be used on a widespread basis because of its excellent capability to highlight and delineate pituitary adenomas.