经扩大鞍隔孔向鞍上生长的垂体腺瘤3例报告

经扩大的鞍隔孔向鞍上生长的垂体腺瘤比较少见,我们曾收治3例。现报告如下。     

多层螺旋CT与MRI增强扫描诊断脑膜瘤的应用价值比较

脑膜瘤是颅内常见肿瘤之一,发病率约占颅内肿瘤的19%,发病年龄多在45岁以上,女性易发〔1〕。因其发病缓、病程长,初步诊断除需要临床表现及全身或神经系统检查,尚应结合多层螺旋CT、MRI增强扫描等了解肿瘤大小和位置〔2,3〕。     

垂体瘤的诊断、鉴别诊断与治疗——垂体腺瘤与鞍区非肿瘤性病变

垂体腺瘤是颅内常见肿瘤，其发病率较高。依据肿瘤细胞的分类不同，临床上可分为多种类型，常见的有催乳素型、生长激素型、促肾上腺皮质激素型等；其相应表现分别为闭经，泌乳；肢端肥大；肾上腺皮质激素分泌过多等症状。依据上述症状，结合影像学及内分泌检查，典型的垂体腺瘤可与鞍区其他常见肿瘤鉴别，如鞍结节脑膜瘤、颅咽管瘤、异位生殖细胞瘤等。但     

脑静脉窦蛛网膜颗粒的CT和MRI诊断

目的 探讨脑静脉窦内蛛网膜颗粒的CT和MRI影像特点。方法 8例脑静脉窦内蛛网膜颗粒患者行MRI检查，其中7例行CT扫描，对影像进行回顾性分析，总结其特征性征象。结果 8例患者中，脑静脉窦内蛛网膜颗粒共有9个，其中6个位于横窦，3个位于上矢状窦。病灶在CT影像中均表现为低密度影，其中3个有钙化灶。9个Tl加权像为低信号，1、2加权像为高信号，7个液体衰减反转恢复序列上为低信号；4个增强后可见轻度或中度强化，以及充盈缺损；4个MR静脉造影影像呈附壁状充盈缺损征象。结论 CT和MRl影像是诊断脑静脉窦内蛛网膜颗粒的有效方法，特别是MRl影像能显示其特征性信号改变及与静脉窦的关系，对诊断更有意义。     

640层CT与1.5T MRI对卵巢癌的诊断价值

目的探讨640层CT与1.5T MRI对卵巢癌的诊断价值。 方法将2016年1月至2018年1月解放军第960医院收治的80例卵巢癌的患者为研究对象,患者术前均行640层CT与1.5T MRI检查,检查后结合手术病理结果对照分析,评估2种方法诊断准确率、病理分期诊断准确率及复发转移敏感度。 结果参照术后病理结果,1.5T MRI卵巢癌诊断准确率、病理分期诊断准确率、复发转移诊断率及敏感度较640层CT明显增高,差异均有统计学意义(P<0.05)。卵巢癌Ⅳ期时和当卵巢癌侵袭转移出现在肠道和腹膜网膜时,2组检查诊断准确率差异无统计学意义(P>0.05)。 结论1.5T MRI在卵巢癌诊断中优势明显,而在卵巢癌Ⅳ期、侵袭及转移到肠道和腹膜网膜时2种设备诊断率无差异,临床可结合患者的实际特点灵活选择。     

肺不典型腺瘤样增生64层容积CT表现与鉴别诊断

［摘要］　目的　探讨肺不典型腺瘤样增生（AAH）的64排容积CT表现及其鉴别诊断。方法　回顾性分析经手术病理确诊的AAH 12例64排容积CT影像资料,与同期确诊的76例局限性磨玻璃密度结节（GGO）患者的CT资料对比,对病灶的部位、大小、形态、边缘征象、内部结构和邻近结构关系进行评价。结果　AAH以纯GGO多见,GGO良性组纯磨玻璃密度结节和混合密度结节均可见,GGO恶性组以混合密度结节为主,分叶征、毛刺征、胸膜凹陷征及血管集束征AAH与良、恶性GGO间比较差异均有统计学意义（P<0.05）,空泡征、细支气管充气征AAH与良、恶性GGO间比较差异均无统计学意义（P>0.05）。结论　AAH以纯GGO为主,直径多<10 mm,无毛刺征、胸膜凹陷征及血管集束征,分析GGO内部实性成分有助于良、恶性的鉴别诊断,但最终确诊仍需组织病理学。     

脑膜瘤的CT诊断

目的探讨并分析临床上CT诊断脑膜瘤的征象与脑膜瘤各种症状表现之间的关系。方法对2002年6月—2011年10月在我院就诊的60例脑膜瘤患者的病例资料进行回顾性分析,并对其CT征象进行总结。结果 60例患者沙砾体型7例(11.67%),成纤维细胞型13例(21.67%),合体细胞型27例(45.00%),血管母细胞型10例(16.66%),恶性型3例(5.00%)。肿瘤位于额顶部8例(13.33%),肿瘤位于小脑凸面11例(18.34%),肿瘤位于中颅凹17例(28.33%),肿瘤位于幕下14例(23.33%),肿瘤位于眼眶内3例(5.00%),肿瘤位于桥小脑角7例(11.67%)。其中高密度脑瘤36例,略高密度脑瘤10例,等密度脑瘤14例。肿瘤呈分叶状7例,肿瘤呈类圆形11例,肿瘤呈圆形42例。结论 CT诊断脑膜瘤能够得到准确的诊断结果,为该病的临床治疗提供有价值的数据。     

CT与MRI诊断53例小肝癌

ＣＴ与ＭＲＩ诊断５３例小肝癌王绪冯守信汪秀玲徐州医学院附属医院放射科江苏省徐州市２２１００２Ｓｕｂｊｅｃｔｈｅａｄｉｎｇｓｌｉｖｅｒｎｅｏｐｌａｓｍｓ／ｄｉａｇｎｏｓｉｓ；ｔｏｍｏｇｒａｐｈｙ，ｘｒａｙｃｏｍｐｕｔｅｄ；ｍａｇｎｅｔｉｃｒｅｓ...     

老年股骨头缺血性坏死的X线、CT和MRI诊断价值

目的 研究老年人早期股骨头无菌性坏死（ANFH）的X线、CT、MRI的诊断价值.方法 对68例老年ANFH病人行双侧股骨头X线、CT和MRI检查,分析其对早期ANFH的显示能力.结果 68例患者均存在早期骨坏死表现.X线发现Ⅰ～Ⅱ期ANFH 28例,诊断准确率41.18%（28/68）;CT发现Ⅰ～Ⅱ期ANFH 39例,诊断准确率为57.35%（39/68）;MRI发现Ⅰ～Ⅱ期ANFH 53例,诊断准确率为77.94%（53/68）.结论 X线平片难以发现ANFH的早期表现,低场MRI结合螺旋CT扫描既可发现早期病变,又可进行分期,是诊断老年人早期ANFH的可靠手段.     

脑膜瘤磁共振成像诊断和相关病理

目的探讨脑膜瘤磁共振成像表现特点及其相关病理类型。方法回顾性分析38例经手术病理证实的脑膜瘤MRI表现,从其信号特点、肿瘤.脑组织界面、瘤周水肿、脑膜尾征、病灶增强后MRI信号均匀度等方面进行归纳、分析,并对照观察相关病理学资料。结果脑膜瘤绝大多数T_1WI呈等信号,T_2WI呈稍高信号和混杂信号,脑膜尾征具有诊断价值。结论脑膜瘤MRI征象有较高的敏感性和特征性,绝大多数能在术前作出正确诊断。     

Differential diagnosis of pituitary tumors

Many parasellar lesions may mimic pituitary adenomas clinically, endocrinologically, and radiologically. Certain patterns do lead suspicion toward the correct diagnosis, whereas in other cases the diagnosis may be difficult. For most of these lesions, the treatment of choice is different from that for a pituitary tumor, so correct diagnosis is of paramount importance. The presenting signs and symptoms as well as radiologic manifestations of parasellar tumors and conditions are discussed.     

Apoplexy of pituitary macroadenoma after combined test of anterior pituitary function

Pituitary apoplexy has been reported as a very rare complication of combined tests of anterior pituitary function and of TRH or gonadotropin-releasing hormone (GnRH) administration in pituitary tumor. A 34-year-old man with a GH-secreting pituitary macroadenoma and diabetes mellitus received an injection of 400 microg TRH, 100 microg GnRH, and 0.15 U/Kg regular insulin. Twenty minutes later, he complained of a severe headache and vomited. Visual acuity and visual field did not change and his headache was persistent during the next 24 hours of conservative management. Magnetic resonance imaging (MRI) of the sella turcica done the day after the event showed definitive elevation of the optic chiasm and slight enlargement of tumor and focal areas of mixed high signal and low signal intensities in the macroadenoma on noncontrast T1-weighted images. Headache subsided markedly within a day of octreotide therapy. Transsphenoidal removal of the pituitary tumor was performed 9 days after the hormone study. Ischemic necrosis and hemorrhage were confirmed in the acidophilic adenoma with positive immunostaining for GH. Postoperative course was uneventful and his serum insulin-like growth factor-1 (IGF-1) level and blood glucose levels were normalized. Three months after the surgery the dynamic test was repeated without adverse effects. To our knowledge, this is a very rare case of apoplexy of GH-secreting pituitary adenoma after a combined stimulation test of anterior pituitary function.     

Empty sella resulting from the spontaneous resolution of a pituitary macroadenoma.

Recent studies suggest that the infarction of a pituitary adenoma may be a frequent cause of an empty sella turcica. However, to date, evidence of such progression has been largely speculative. We present the case of a patient with a pituitary macroadenoma that underwent spontaneous involution resulting in an empty sella, as documented by serial magnetic resonance imaging scans. A brief review of the proposed causes of primary empty sella, with emphasis on pituitary necrosis, is provided.     

Corticotrophic macroadenoma of the pituitary associated with hypoadrenalism

A 60-year-old man underwent transfrontal surgery for a macroadenoma of the pituitary which presented with chiasmal compression, and immunohistochemical examination of the resected specimen revealed a corticotrophic tumour. Despite subsequent external irradiation, he was left with a large tumour remnant, which continued to grow. There were no clinical signs of Cushing's syndrome either before or after surgery and 24 h urine excretion of cortisol was not elevated. Plasma ACTH concentrations were marginally raised. However, there was loss of circadian variation in serum cortisol concentrations and administration of high-dose oral dexamethasone was followed by a marked and reproducible rise in both ACTH and cortisol. Two years later he developed symptoms and signs of hypoadrenalism and urine cortisol excretion was low, even though the paradoxical response to dexamethasone was preserved. Treatment with 0.5 mg dexamethasone each day was associated with partial resolution of his symptoms and urine cortisol concentration rose into the normal range. This treatment was maintained until his death in hospital in April 1988. The possible mechanism underlying the association between a corticotrophic tumour and hypoadrenalism are discussed.     

TSH-secreting pituitary macroadenoma: rapid tumor shrinkage and recovery from hyperthyroidism with octreotide

A 44-year-old man with atrial fibrillation caused by hyperthyroidism is described. The underlying disease was a TSH-secreting macroadenoma of the pituitary. Treatment with the somatostatin analog octreotide eliminated hyperthyroidism and atrial fibrillation within 4 days and the tumor size diminished substantially within 3 weeks.     

CT and MRI diagnosis of hepatic epithelioid hemangioendothelioma

BACKGROUND:Hepatic epithelioid hemangioendothelioma (EHE)is a rare,low-grade malignant vascular tumor.Although its unusual imaging and pathologic findings are being recognized with increasing frequency,diagnosis is still difficult.This study aimed to analyze the CT and MRI features of hepatic EHE with a pathological study in order to improve the diagnostic accuracy and knowledge of this disease in daily practice. METHODS:Nine patients with hepatic EHE confirmed pathologi- cally underwent plain and dynamic c...     

ACTH-producing remnants following apoplexy of an ACTH-secreting pituitary macroadenoma

Describe a case of apoplexy of an ACTH-producing pituitary adenoma which resulted not only in an empty sella with concurrent hypothyroidism, hypoprolactinemia, and hypogonadism but persistent hypercortisolemia from two distinct extrasellar remnants of the original adenoma. Review the literature to identify other similar cases. The patient’s medical history, physical exam, lab data, imaging exams and histopathological results were analyzed and compiled into a case report, and an extensive review of the literature was performed. Endocrinological data revealed hypercortisolism and an elevated ACTH with an otherwise suppressed pituitary axis. A pituitary MRI showed a macroadenoma in the left cavernous sinus in addition to an empty sella. An octreotide scan revealed lesions in the left sella turcica and the right sphenoid sinus. Tissue samples of both lesions stained positive for ACTH and negative for GH, prolactin, FSH, LH, and TSH. The lesions were surgically removed, and the patient treated with radiation and ketoconazole. This resulted in a significant decrease in ACTH and cortisol as well as a marked improvement in blood glucose control. The review of literature revealed the absence of any similar cases in the past. The patient presented with apoplexy of an ACTH-secreting pituitary macroadenoma with two hormonally active extrasellar remnants. Several cases in the literature describe recurrence of Cushing’s disease following infarction of ACTH-secreting adenomas. This is the first documented case of infarction of an ACTH-producing adenoma resulting in two distinct ACTH-producing remnants without recurrence of the original adenoma.