大及巨大垂体腺瘤经蝶入路切除术后疗效评估-MRI动态观察

目的分析比较大和巨大垂体腺瘤经蝶手术后不同时期核磁共振检查的影像学特点,探讨MRI对手术疗效评估的最佳时机。方法追踪、随访直径≥2cm垂体腺瘤72例,其中PRL瘤37例,无功能性腺瘤25例,GH腺瘤2例,ACTH腺瘤2例,多分泌激素腺瘤6例。分别于术后早期(术后1～2周)、三个月、半年核磁共振检查,其中45例MRI随访一年以上,进行动态观察比较。结果72例术后早期MRI复查确定瘤影完全消失34例(47．2%)；11例术后早期MRI检查报告残留,半年后复查3例消失,8例残留；27例(37．5%)术后早期MRI不能明确判定疗效,半年后复查完全切除22例,5例残留。45例术后随访一年,其MRI表现与术后半年的表现相似。结论术后半年的MRI能较好的判断手术效果,有利于术后辅助治疗方案的选择。

Evaluation of transsphenoidal surgical effect on large and giant pituitary adenomas-analysis of serial MRI

Objective It was often difficult to evaluate the transsphenoidal microsurgical effects on large and giant pituitary adenomasvaluate in the early postoperative period,especially on nonfunctioning adenomas.In this study,the distinguishing features of MRI in the different postoperative periods were analyzed in order to confirm the best time of evaluation oftranssphenoidal microsurgical effects on large and giant pituitary adenomas.Methods 72 pituitary adenomas larger than 2 cm in diameter were followed up, including 37 PRL-secreting adenomas,25 nonfunctioning adenomas,2 GH-secreting adenomas,2 ACTH-secreting adenomas and 6 multi-secreting adenomas.MRI examinations were taken between one or two weeks,three months,half a year,respectively after operation.45 of them were followed up for more than one year after surgery,and the results were analyzed.Results In the early postoperative period,MRI scans showed that 34 cases(47.2%)were completely removed,11 cases were diagnosed to have residual tumors in early MRI,half a year after surgery.MRI scans showed that the residual tumors in 3 cases disappeared and 8 of them had residual tumors.27 cases(37.5%)were suspected of apparent operational effect in MRI of the early postoperative period half a year after operation.MRI showed that the adenomas in 22 cases were completely removed and residual tumors were seen in 5 cases.In 45 cases,the images by MRI half a year after surgery were similar to those taken one year after surgery.Conclusion MRI taken half a year after surgery can be used to evaluate the operational effects,which is advantageous for the selection of adjuvant treatments after operation.