MR垂体柄高信号变化对经蝶内镜手术后尿崩症的预警意义

目的探讨经蝶内镜手术前后的垂体柄及后叶高信号是否可以预测尿崩的发生率及其持续时间。方法回顾性分析 2015年 8月至 2021年 1月徐州医科大学附属医院收治的 160例经蝶内镜治疗的鞍区肿物病人的临床资料。术前根据垂体柄高信号的形态特征将其分为三组:垂体柄远端卵圆形( A组)，垂体柄远端呈线形( B组)，整个垂体柄呈线形( C组)。比较各组尿崩症的发生情况，总结三组病人尿崩症发生率的持续时间。总结垂体柄高信号和后叶高信号与尿崩症之间的关系。结果术前发生尿崩症 6例( 3.7%)后叶均未见高信号。术后一过性尿崩 76例( 47.5%)永久性尿崩 9例( 5.6%)。 160例病人中术后 1周 67例( 41.8%)术前垂体后叶未见高信号其中 64例( 95.5%)术后发生一过性的尿，崩， 92例( 57.5%)术前垂体柄出现高信号其中 76例( 82.6%)术后发生一过性尿崩，两者均与术后尿崩症的发生显著相关( P<0.001)。术前垂体后叶无高信号病人( A组52.4%；B组 68.4%；C组 91.7%)尿崩持续时间( A组 4.86 d；B组 46 d；C组 336.67 d)后叶高信号的恢复时间( A组 108 d；B组204 d；C组 687 d)，C组尿崩持续时，间及后叶的恢复时间最长， B组次之， A组最短。其中，C组中有 3例出现了永久性尿崩，且垂体柄有持续的高信号。结论垂体柄高信号的出现和后叶高信号的缺失提示术后发生尿崩，如果垂体柄为高信号则是一过性的尿崩。根据垂体柄中高信号的长度可以预测尿崩持续的时间，这与抗利尿激素(ADH)的转运障碍的程度相一致。

Early warning significance of pituitary stalk hyperintensity changes in patients with diabetes insipidus after transsphenoidal endoscopic surgery

Objective To investigate whether the presence of hypersignal in the pituitary stalk and posterior lobe after transsphenoidal endoscopic surgery can predict the incidence and duration of diabetes insipidus.Methods The clinical data of 160 patients withsellar mass treated by transspenoidal endoscopy from August 2015 to January 2021 were retrospectively analyzed. According to the morphological characteristics of hypersignal of pituitary stalk, they were assigned into three groups: the distal end of the pituitary stalk wasoval (group A), the distal end of the pituitary stalk was linear (group B), and the whole pituitary stalk was linear (group C). The incidence of diabetes insipidus in each group was compared, and the duration of the incidence of diabetes insipidus in 3 groups was summarized. The relationship between hypersignal of pituitary stalk and posterior lobe and diabetes insipidus were summarized. Results There was no high signal in posterior lobe of 6 patients (3.7%) with diabetes insipidus. Postoperative transient diabetes insipidus wasfound in 76 cases (47.5%) and permanent diabetes insipidus in 9 cases (5.6%). Of the 160 patients, 67 (41.8%) had no preoperativelyhigh signal in the posterior pituitary lobe, 64 (95.5%) had postoperatively transient diabetes insipidus, and 92 (57.5%) had preoperatively high signal in the pituitary stalk, 76 (82.6%) had postoperatively transient diabetes insipidus. Both were significantly associatedwith the incidence of diabetes insipidus after surgery (P<0.001). Patients without high signal in the posterior pituitary before surgery(group A 52.4%; group B 68.4%; group C 91.7%), duration of diabetes insipidus (group A 4.86 days; group B 46 days; group C 336.67days), the recovery time of posterior lobe high signal (group A 108 days; group B, 204 days; group C (687 days) had the longest durationof diabetes insipidus and the recovery time of posterior lobe in group C, followed by group B and group A. Among them, three patientsin group C developed permanent diabetes insipidus with persistent hypersignal in the pituitary stalk.Conclusion The occurrence of high signal in the pituitary stalk and the absence of high signal in the posterior lobe suggest the occurrence of diabetes insipidus aftersurgery. If the pituitary stalk is high signal, it is transient diabetes insipidus. The duration of diabetes insipidus can be predicted by thelength of hypersignal in the pituitary stalk, which is consistent with the degree of disruption of antidiuretic hormone (ADH) transport.