垂体瘤MRI影像学特征与视功能障碍

目的 通过对垂体瘤MRI影像学特征的研究,结合患者的神经眼科学表现,进一步探讨垂体瘤导致患者视功能障碍的可能原因.方法 将48例垂体瘤患者分为视交叉受压移位和视交叉未受压两组,比较两组患者视力下降率和视野缺损率的差异.以MRI正中矢状位和冠状位肿瘤的相对高度为自变量,患者双眼视力下降值为应变量进行直线相关和回归分析.结果 48例垂体瘤患者中,38例(79%)视交叉受压向上移位,视力下降率和视野缺损率分别为78%和54%,10例(21%)视交叉未受肿瘤压迫,视力下降率和视野缺损率分别为60%和30%,两组患者视力下降率和视野缺损率差异均无统计学意义.MRI正中矢状位和冠状位肿瘤相对高度平均值分别为2.0±1.2(0.0～5.5)cm和1.7±1.1(0.0～5.0)cm,双眼视力下降值平均0.9±0.6(0.0～1.9),肿瘤的相对高度与患者双眼视力下降值呈正相关关系.结论 除视交叉受肿瘤压迫和窃血机制外,视交叉供血动脉受累亦可能是垂体瘤患者出现视功能障碍的重要原因.

Pituitary adenomas: MRI radiological characteristics and visual disturbance

Objective To study magnetic resonance imaging(MRI)radiological characteristics and neuro-ophthalmology to demonstrate the cause of visual disturbance(VD)of pituitary adenomas(PAs) patients.Methods Forty eight patients with PAs were selected.Their medical records and MRI radiological films were reviewed.And the patients were divided into optic ehiasma(OC)invasion group and noninvasion group.The relationship between the tumor and the OC were studied with neuro-ophthalmological findings.The relative heiights of the tumor on the median sagittal and coronal MR images were taken as independent vailables respectively.The vatues of visual loss(VL)in double eyes were selected as dependent variables.Then,the linear correlation and regression were carded out.Results In 48 patients.there were 38 cases(79%)with suprasellar extension of tumom and upward displacement of the OCs.The rates of VL and visual field defects(VFDs)were 78%and 54%,respectively.There were 10 cases (21%)without chiasmal jnvolvement.The rates of the VL and the VFDs were 60%and 30%,respectively.There was no significant difference between the two groups in the rates of VL and the same results could be found about VFDs.The relative height of tumors was 2.0±1.2(range,from 0.0 to 5.5)cm as measured from the median sagittal MR images and 1.7±1.1(range.from 0.0 to 5.0)cm as measured from the coronal MR images.The decrease value of visual acuity in the double eyes was 0.9±0.6 (range,from 0.0 to 1.9).The relative heishts of the tumors,no matter measured from the median sagittal or coronal MR images,were linearly significantly correlated with the visual acuity decrease vatue of the double eyes,Conclusion Besides chiasma invasion and stealing blood.the invasion of chiasmal arteries nlight be a important cause for visual disturbance of pituitary adenomas patients.