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。

The Study of the Correlations between MRI and Expression of MMP 9 in Invasive Pituitary Adenomas

Objective To study the correlations of MRI characteristics with the expression of MMP 9 in invasive pituitary adenomas which invaded the sellar floor and cavernous sinus. Materials and Methods 90 patients with pituitary adenomas confirmed by operation and pathology were collected. The expression of MMP 9 was assessed by immunohistochemial staining (SP method). The correlation of the expression of MMP 9 with MRI characteristics of invasive pituitary adenomas was assessed. Results There were 59 cases of invasive pituitary adenomas proved by operation. Penetrated tumors in sphenoid sinus were seen in 30 cases (58.8%), and sensitivity, specificity, positive predictive value and negative predictive value were 59%,100%,100%,65% respectively. The adenoma crossed the lateral internal carotid line can be seen in 95%(57/60)of invasive pituitary adenomas invaded cavernous sinus (SEN 95%,SPE 100%, PPV 100%, NPV 98%). When 2/3 or more of the perimeter of the intracavernous ICA was encased by 37 adenomas, the cavernous sinus was always invaded (SEN 62%,SPE 100%,PPV 100%, NPV 84%). The expression of MMP 9 of the pituitary adenomas which invaded the sellar floor and cavernous sinus was higher than that of pituitary adenomas without invasion. Conclusion The presence of penetrated tumors in sphenoid sinus sella is a good sign of the sellar floor invasion. Invasion of the cavernous sinus is certain if the adenoma crossed the lateral internal carotid line or the encasement of intracavernous ICA more than 2/3.