MRI对侵袭性垂体瘤的诊断价值及其临床意义

目的 研究MRI对侵袭性垂体瘤的诊断价值及其意义。方法 29例经手术病理证实的侵袭性垂体瘤病人，使用0．5T的MRI机，选用自旋回波行矢状位、轴位和冠状位T1WI，轴位或冠状位PDWI、T2WI，增强后行矢状位、轴位或冠状位T1WI扫描，并与手术病理资料对比分析。结果 肿瘤多为等T1等或长T2信号。增强扫描呈均匀或不均匀强化。向周围组织浸润表现为鞍底受侵下陷，部分肿瘤突入蝶窦；颈动脉包绕，海绵窦受累；鞍隔突破等。10例MRI示0级浸润病例，术中证实均无海绵窦侵犯；14例MRI示1级浸润病例．3例证实肿瘤侵犯海绵窦，并包绕颈内动脉；20例MRI示2级海绵窦侵犯病例，15例证实有海绵窦侵犯；9例MRI示3级浸润病例，8例证实肿瘤侵入海绵窦及颈内动脉外侧间隙；5例MRI示4级浸润病例，术中证实均有海绵窦侵犯，并包绕颈内动脉。结论 MRI可为术前诊断垂体瘤的侵袭性提供依据，对选择手术方法和制定治疗方案有重要指导意义。

THE VALUE OF MRI IMAGING AND ITS SIGNIFICANCE IN THE DIAGNOSIS OF INVASIVE PITUITARY ADENOMA

Objective To assess the value and significance of MRI imaging in the diagnosis of invasive pituitary adenoma. Methods Twenty-nine patients with invasive pituitary adenoma confirmed by surgery and pathology were imaged with sagittal,coronal T_1WI,or coronal PDWI and T_2WI,sagittal,coronal or T_1WI after Gd-DTPA injection,spin-echo sequences,using 0.5 T MRI scanner.MRI findings were analyzed and compared with surgical and pathological results. Results The MRI appearance of the tumors was equal signal intensity in T_1WI,equal or high signal intensity in T_2WI,and even or uneven enhancement after Gd-DTPA injection.MRI findings included invasion of the sella turcica and adjacent bones,involvement of sphenoid sinus and cavernous sinus,encasement of internal carotid artery.Ten patients with grade-0 invasion on MRI were found to have non-involvement of cavernous sinus during surgery;14 cases with grade-1 invasion on MRI,three of them showed involvement of cavernous sinus and encasement of internal carotid artery;in 20 cases with grade-2 involvement of cavernous sinus on MRI,15 were confirmed by surgery;in nine cases with grade-3 invasion on MRI,eight were found to have invasion of cavernous sinus and lateral interspace of internal carotid artery;in five with grade-4 invasion on MRI,four had involvement of cavernous and encasement of internal carotid artery. Conclusion MRI is helpful in providing information on invasion of pituitary neoplasms for preoperative diagnosis,which is of great instruction significance for the management of the disease.