动态增强MRI在垂体腺瘤诊断中的应用

目的 探讨动态增强MRI(DCE-MRI)的定性、半定量、定量参数在垂体腺瘤诊断中的应用价值。方法 采用回顾性病例对照研究方法,收集2014年8月—2018年3月蚌埠医学院第一附属医院收治的23例垂体腺瘤患者的临床和影像资料,均经临床及病理等确诊,男9例、女14例,年龄29~70岁;其中垂体微腺瘤9例(垂体微腺瘤组)、垂体大腺瘤14例(垂体大腺瘤组);选取8例常规颅脑检查垂体正常者作为对照组,男3例、女5例,年龄28~67岁。研究对象均行DCE-MRI,获得感兴趣区域的时间-信号强度曲线(TIC)进行分型定性分析,并测量DCE-MRI半定量参数达峰时间(TTP)、最大上升斜率(MSI)和定量参数容积转运常数(K^trans)、回流速率常数(K_ep)值,采用单因素方差分析及Kruskal-Wallis 检验进行组间比较。结果 垂体微腺瘤组TIC Ⅰ、Ⅱ、Ⅲ型分别为0、7、2例,垂体大腺瘤组分别为10、3、1例,对照组分别为7、1、0例,差异有统计学意义(Z=11.346, P＜0.01);对照组与垂体微腺瘤组、垂体微腺瘤组与垂体大腺瘤组比较,差异均有统计学意义(P值均＜0.05)。对照组的TTP[(48.52±15.83)s]小于垂体微腺瘤组[(80.79±19.32)s]和垂体大腺瘤组[(70.42±21.64)s],MSI(3.92%±1.24%)及K^trans[(1.08±0.22)min^-1]、 K_ep[(1.34±0.40)min^-1] 值均大于垂体微腺瘤组[1.89%±1.04%、(0.45±0.18)min^-1、(0.86±0.22)min^-1] 和垂体大腺瘤组[2.79%±1.06%、(0.69±0.28)min^-1、(0.95±0.28)min^-1],差异均有统计学意义(P值均＜0.05);垂体大腺瘤组MSI、K^trans均大于垂体微腺瘤组,差异均有统计学意义(P值均＜0.05)。结论 DCE-MRI中TIC曲线可以鉴别垂体腺瘤,半定量参数TTP、MSI和定量参数K^trans、K_ep能够进一步诊断垂体微腺瘤;MSI、K^trans能够鉴别垂体微腺瘤和大腺瘤。

The value of dynamic contrast enhancement MRI in diagnosis of pituitary adenoma

Objective To explore the application value of qualitative, semi-quantitative and quantitative parameters in dynamic enhanced MRI(DCE-MRI)in the diagnosis of pituitary adenoma.Methods The retrospective case-control study was conducted. The pituitary adenomas were collected in the First Affiliated Hospital of Bengbu Medical College from August 2014 to March 2018. Twenty-three cases of pituitary adenomas confirmed by clinical and pathological diagnosis were examined by DCE-MRI, including 9 males and 14 females with age of 29-70 years. Among them, there were 9 cases of microadenoma (microadenoma group) and 14 cases of macroadenoma (macroadenoma group). Eight cases of normal pituitary were selected as a control group, including 3 males and 5 females with ages of 28-67 years. Then obtain time-signal intensity curve (TIC) of these cases which consequently were classification and qualitatively analyzed. The time to peak (TTP), maximum slope of increase (MSI), volume transfer constant (K^trans) and exchange rate constant (K_ep) were measured. The single factor variance analysis and Kruskal-Wallis test were used for the above parameter.Results The number of microadenomas TIC three types of curves were 0, 7, 2; macroadenoma were 10, 3, 1; normal pituitary were 7, 1, 0. Difference was statistically significant(Z=11.346, P＜0.01). Compared with other three groups, the TIC types in the control group were significantly different (all P values＜0.05). The values of TTP [(48.52±15.83)s] with control group less than the microadenoma group [(80.79±19.32)s] and macroadenoma group[(70.42±21.64)s]; MSI(3.92%±1.24%), K^trans [(1.08±0.22)min^-1] and K_ep[(1.34±0.40)min^-1] of control group higher than microadenoma group [1.89%±1.04%,(0.45±0.18)min^-1,(0.86±0.22)min^-1] and macroadenoma group [2.79%±1.06%, (0.69±0.28)min^-1, (0.95±0.28)min^-1], the differences were statistically significant(all P values＜0.05). The MSI and K^trans values of macroadenoma were higher than those of microadenomas, the differences were statistically significant(all P values＜0.05).Conclusions The TIC types can be used in differential diagnosis of pituitary adenoma. The TTP, MSI, K^trans and K_ep parameters can be further used to diagnose microadenomas. The parameters of Slopemax and K^trans can be used in differential diagnosis of microadenoma and macroadenoma.