儿童和青少年垂体疾病的MRI诊断

目的观察儿童和青少年各种垂体病变的临床和MRI特点.方法回顾分析临床、MRI及病理证实的31例患者的各类垂体病变共49个,其中21例有局限性垂体病变,10例有多处垂体病变共28个.结果垂体性侏儒症(n=13)主要病因有垂体矮小(n=8)和大腺瘤(n=5).4例垂体矮小合并垂体柄纤细和异位后叶.原发性中枢性尿崩症(n=13)均有垂体后叶异常,8例有垂体柄的异常(2例纤细,6例增粗).Langhan's细胞增多症(LCH)与转移瘤各3例,它们均有垂体柄增粗和后叶短T1信号消失,但LCH有扁骨的破坏,而转移瘤均见垂体柄外的颅内转移灶.本组垂体瘤影像学及手术均未见侵袭性生长.5例微腺瘤均为催乳素瘤.3例垂体大腺瘤(3/7)有卒中.无卒中的大腺瘤与垂体增生在MRI表现相似,但临床表现不同.结论 MRI能准确显示儿童和青少年各类垂体病变, 临床与影像特点相结合能正确诊断该类病变.

MRI diagnosis of pituitary lesions in childhood and adolescence

Objective To observe the clinical and MRI features of various pituitary lesions in childhood and adolescence. Methods The MRI findings and clinical features of 31 cases, which had 49 different kinds of pituitary lesions were retrospectively reviewed (21 cases had single lesion, 10 cases had multiple lesions). Results The main causes of pituitary growth hormone deficiency (PGHG) were macroadenomas and hypoplasia of pituitary. Four cases of pituitary hypoplasia were combined with agenesis of stalks, as well as ectopic posterior lobe. In all 13 cases of central diabetes insipidus (CDI), the high signal of posterior lobe did not appear in T1W sagittal images. Eight in 13 of CDI had abnormality of pituitary stalk (2 had thin and 6 had thick stalk). There were 3 cases of Langhan's histocytosis (LCH) and 3 cases of stalk metastases. All of them showed a thickened pituitary stalk, but LCH cases demonstrated additional destruction of flat bones (n=3). In the cases with stalk metastases, brain metastatic lesions could be detected besides stalk lesions (n=3). There were no signs of invasive growth on MRI and after resection in all cases with adenomas. All 5 microadenomas were PRL secreting ones. Three in 7 cases of pituitary macroadenomas had apoplexy. The hyperplasia pituitary had similar imaging features as pituiary adenomas which showed no signs of apoplexy, but their clinical appearance were quite different. Conclusion MRI can show different kinds of pitiuitay lesions clearly, combined with clincal manifestations can make correct diagnosis of pituitary lesions in childhood and adolescence.