垂体促肾上腺皮质激素腺瘤的MRI特点和手术疗效

Bing Xing*, Kan Deng, Zu-yuan Ren,et al. Magnetic Resonance Imaging Characteristics and Surgical Results of Adrenocorticotropin -secreting Pituitary Adenomas，Chin Med Sci J,2008,23(1):44-48
幸兵* 邓侃 任祖渊 等，垂体促肾上腺皮质激素腺瘤的MRI特点和手术疗效，中国医学科学杂志(英文版),2008,23(1):44-48北京协和医院神经外科幸兵

关键词 垂体促肾上腺皮质激素腺瘤  磁共振 诊断 治疗
     Objective  To evaluate magnetic resonance imaging (MRI) characteristics and surgical results of  adrenocorticotropin (ACTH)-secreting pituitary adenomas.
     Methods  MRI characteristics and relationship between MRI positive rate and surgical results of 266 patients with pathologically confirmed Cushing’s disease were analyzed retrospectively. All patients underwent thin-section sagittal and coronal　scans of the pituitary gland before and after administration of gadolinium-diethylene triaminepenta acetic acid (Gd-DTPA) on a 1.5-Tesla MRI scanner, and  dynamic enhanced MRI were performed in  39 patients. All patients underwent transsphenoidal adenomectomy. Endocrinological examinations and assessment were performed.
     Results  Preoperative MRI revealed normal results in 41 (15.4%) cases, microadenoma in 179 (67.3%), macroadenoma in 42 (15.8%) and huge adenoma in 4 (1.5%).Pituitary apoplexy occurred in 13 (4.9%). Positive rate of ACTH-secreting adenoma was 84.6%(225/266) on MRI scans,and that of small microadenomas was 87.2%(34/39) on dynamic enhanced MRI scans.Preoperative endocrinological tests of 199 cases supported the diagnosis of typical Cushing’s disease, while the other 67 cases had atypical endocrinological results .The endocrinological cure rate, remission rate and ineffective rate were 85.7%、9.3% and 7.5% , respectively. There was no difference in the initial endocrinological cure rate between the  patients with positive and normal MRI results(90% vs 87.8% , P=0.904).
     Conclusions  Enhanced coronal pituitary MRI is helpful for preoperative localization of  ACTH-secreting pituitary microadenoma. Dynamic enhanced MRI may improve detection rate of microadenoma . There  was no marked difference in the surgical results for patients with preoperative MRI results indicating presence or absence of microadenoma.