海锦窦侵袭性垂体腺瘤的MRI和生物学标志的临床实验研究

目的探索MRI和分子生物学标志在评价垂体腺瘤侵袭性行为中的作用。方法对45例垂体腺瘤患者术前的MRI、术中所见结果和术后组织标本免疫组化分析结果进行前瞻性研究。结果MRI预测海绵窦侵袭的敏感性60％,特异性85％,阳性预测值83％,阴性预测值63％;免疫组化分析侵袭性垂体腺瘤的MvD、Ki-67标记指数、VEGF和MMP-9表达明显高于非侵袭性垂体腺瘤(统计学分析P值分别为：<0．001、=0．039、<0．001和<0．001);但侵袭性垂体腺瘤的nm23表达却明显低于非侵袭性垂体腺瘤(P<0．001);另外,统计学分析c-myc标记指数和Bcl-2表达与垂体腺瘤的侵袭性无关(P=0．061和P=0．201)。结论增强扫描的MRI对海绵窦侵袭性垂体腺瘤的术前判断有一定参考价值;MVD、Ki-67标记指数、VEFG、MMP-9和nm23表达与垂体腺瘤的侵袭性有关。

Magnetic Resonance Imaging and Biological Markers in PituitaryAdenomas with Invasion of the Cavernous Sinus Space

Objective: To investigate the predictability of MRI and the possible biological markers of cavernous sinus invasion of pituitary adenomas associated with four phenomenas: angiogenesis, cell proliferation, apoptosis and matrix metalloproteinase. Methods: We evaluated 45 patients with pituitary adenoma according to the MRI, surgical findings and the immunohistochemistry staining of tumor tissues. Results: The results have shown that the sensitivity of MRI for predicting cavernous sinus invasion in this prospective study was 60%, its specificity 85%, its positive predictive value 83.33%, negative predictive value 62.96%. 45 specimens of pituitary adenomas were analyzed for expression of F8, VEGF, Ki-67, c-myc, Bcl-2, nm23 and MMP-9 immunoreactivity using immunoperoxidase staining. MVD was assessed using F8-related antigen. The results have shown that MVD of invasive pituitary adenomas was significantly higher than that of noninvasive (P<0.001). There was an association between the invasion of pituitary adenomas and Ki-67 LI (P=0.039) or the expression of VEGF (P<0.001) and MMP-9 (P<0.001). But c-myc LI and Bcl-2 expression have no association with invasiveness of pituitary adenomas (P=0.061 versus P=0.201). On the other hand, there is an inverse relationship between nm23 expression and tumor invasion (P<0.001). Conclusion: Parasellar extension of pituitary adenomas through the medial wall of the cavernous sinus is diagnosed at surgery, and with sensitive gadolinium-enhanced MRI, its extent can be partly determined by radiology. Although our study has shown that MVD and the expression of VEGF, Ki-67, nm23 and MMP-9 have associations with invasiveness of pituitary adenomas, they are lack of specificity. These markers can only provide some useful information.