动态增强MRI及TSE序列在垂体微腺瘤诊断中的临床应用
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摘要
目的
通过分析垂体柄、正常垂体腺前叶、垂体微腺瘤三者的时间–增强比及正常垂体腺前叶与垂体微腺瘤的时间–对比度曲线特点,评价动态增强1.5T MRI技术对垂体微腺瘤的检出率。
材料与方法
收集主要来源上海交通大学苏州九龙医院,2008年1月到12月间28例受检者,女24例,男4例,年龄13～77岁(平均年龄27.76±12.35岁)。使用Siemens Magnetom Anvato,1.5T超导磁共振扫描仪。
应用Mean Curve软件分析,将感兴趣区(ROI)0.1mm2分别置于垂体柄、正常垂体腺前叶、垂体微腺瘤和颅外噪声区,分别得出其时间﹣信号强度曲线,分别分析其强化峰值,并以增强的峰值和平扫时感兴趣区的信号强度为对照计算出相应增强比(Contrast Enhanced Ratio,CER)。
采用双盲法对垂体微腺瘤检出分级的评定方法如下:I级垂体腺未见异常信号灶;II级垂体微腺瘤,境界不清;III级垂体微腺瘤,境界清楚。I级为病灶检出阴性,II、III级为病灶检出阳性。
使用SAS8.0软件,以t检验和χ2检验对统计结果进行分析。
结果
1对感兴趣区分别测量垂体柄、正常垂体腺前叶、垂体微腺瘤三者的峰值、强化率及三者间比较如下:
1.1正常垂体柄强化峰值见于29.32±15.89s,垂体柄峰值的强化率为平扫时的149.72±61.47%。
1.2正常垂体腺前叶强化峰值较垂体柄的强化峰值出现晚,见于58.32±22.40s,正常腺前叶峰值的强化率较垂体柄的高,为218.25±56.87%。垂体柄和正常垂体腺前叶的强化峰值的出现和强化比率的差异均具有统计学意义(P<0.01)。
1.3垂体微腺瘤一般在平扫及动态增强早期为低信号灶,垂体微腺瘤的强化峰值较正常垂体腺前叶强化出现晚,见于103.89±25.38s,垂体微腺瘤的强化比率亦较正常垂体腺前叶低,为163.32±77.35%。正常垂体腺前叶与垂体微腺瘤的峰值出现时间和强化比率的差异均具有统计学意义(P <0.01)。
2正常垂体腺前叶和垂体微腺瘤的最大对比见于71.04±24.09s,最大对比度为46.71±11.86%。
3本组28个病例中,平扫对垂体微腺瘤的检出率为32.14%(9/28),动态增强对垂体微腺瘤的检出率为82.14%(23/28),常规增强扫描对垂体微腺瘤的检出率为57.14%(16/28)。平扫与动态增强对垂体微腺瘤的检出率间有统计学意义(P <0.05);动态增强与常规增强扫描对垂体微腺瘤的检出率间无统计学意义(P >0.05)。
结论
1动态增强早期对垂体微腺瘤的检出很关键,即静脉注入Gd-DTPA对比剂后立即扫描,垂体微腺瘤就易检出。
2动态增强早期时相,垂体微腺瘤与周围正常垂体组织间的对比度较大,显示病灶效果最佳。
3动态增强早期对病灶的检出率最高,常规增强能够作为动态增强的补充,如果两者联合应用能够对病灶的检出率更高,而不致造成漏诊。
Objective:Through analyzsing the three time-signal intensity curves of the stalk, the normal pituitary gland anterior lobe and the pituitary microadenoma, And the time-enhancement curve of the normal pituitary gland anterior lobe and the pituitary gland microadenoma. And appraise the technology of dynamic contrast-enhanced 1.5T MRI to detection rate of the pituitary gland microadenoma .
Material and methods:Collection the source Shanghai Jiaotong University Suzhou Kowloon Hospital,from January, 2008 to December 28 patients,Female 24,Men 4,Age 13～77 years old (average age 27.76±12.35 years old),Apply Siemens Magnetom Anvato, 1.5T superconductivity magnetic resonance scanner .
Using Mean Curve software analysis,Put the interest of review (ROI) 0.1mm2 in the stalk, the normal pituitary gland anterior lobe, the pituitary gland microadenoma and the skull external noise area, separately. Obtain time-signal intensity curve separately. And analysis strengthening peak value. Calculate the Contrast Enhanced Ratio of strengthening peak value and the signal intensity of interest area .
Uses double picking out the graduation to the pituitary gland microadenoma blindly and the evaluation method to be as follows:I Pituitary gland has not seen the unusual signal. II The pituitary gland microadenoma boundary is unclear. III The pituitary gland microadenoma is clear.The I level is negative and the II、III level is posative .
Apply the SAS8.0 software,Aanalysis by the T-test and theχ2-tese to the statistical result .
Results:
1 Pituitary salk,anterior pituitary,pituitary microadenomas three peaks,enhanced rate and among the there are as follows:
1.1 Normal pituitary stalk enhanced peak at 29.32±15.89s,The strengtren-ratio of pituitary stalk to it’s plain’s is 149.72±61.47%.
1.2 The enhanced-peak of anterior pituitary is later than the pituitary stalk,s,at 58.32±22.40s,The strengtren-ratio of anterior pituitary is higher than the pituitary stalk’s,at 218.25±56.87%,The differences of the ehanced-peak and strengtren-ratio between the pituitary stalk and anterior pituitary are statistically significant(P<0.01). 1.3 The both of pituitary microadenomas generally plaining and dynamic contrast-enhanced scanning show low signal, The enhanced-peak of pituitary microadenomas is later than the normal pituitary gland’s,at 103.89±25.38s,The strengtren-ratio of pituitary microadenomas is also lower than the normal pituitary gland,s,at 163.32±77.35%. The differences between the ehanced-peak and strengtren-ratio of anterior pituitary and pituitary microadenomas are statistically significant(P<0.01).
2 Betwwen the largest seening contrast of anterior pituitary and pituitary microadenomas is at 71.04±24.09s,the greatest contrast to 46.71±11.86%.
3 This group 28 cases,The plain detecting the rate of pituitary microadenomas is 32.14%(9/28),dynamic enhancement showing the rate is 82.14%(23/28),conventional enhanced scan showing the rate 57.14%.The detection rate of pituitary microadenomas between plain and dynamic contrast-enhanced scan is statistically significant (P<0.05). The detecting rate of pituitary microadenomas between dynamic contras-enhanced and conventional enhancement has no statistically significance(P>0.05).
Conclusion:1 It is very essential that the dynamic contrast-enhancement picks out the pituitary gland microadenoma at early time. After namely the vein poured into the Gd-DTPA contrast agent, scanning immediately, the pituitary gland microadenoma is easy to pick out.
2 At the dynamic contrast-enhanced early time phase,The contrast gradient between the pituitary gland microadenoma and the normal pituitary gland organization is more obvious. Demonstrating the effect of lesion is best .
3 The dynamic contrast-enhanced detecting the lesion is the highest rate at early time.The conventiontional enhancement scan takes the dynamic contrast-enhanced supplement. If both union application can be higher detecting rate, but does not create leaking lesions.
通过分析垂体柄、正常垂体腺前叶、垂体微腺瘤三者的时间–增强比及正常垂体腺前叶与垂体微腺瘤的时间–对比度曲线特点,评价动态增强1.5T MRI技术对垂体微腺瘤的检出率。
材料与方法
收集主要来源上海交通大学苏州九龙医院,2008年1月到12月间28例受检者,女24例,男4例,年龄13～77岁(平均年龄27.76±12.35岁)。使用Siemens Magnetom Anvato,1.5T超导磁共振扫描仪。
应用Mean Curve软件分析,将感兴趣区(ROI)0.1mm2分别置于垂体柄、正常垂体腺前叶、垂体微腺瘤和颅外噪声区,分别得出其时间﹣信号强度曲线,分别分析其强化峰值,并以增强的峰值和平扫时感兴趣区的信号强度为对照计算出相应增强比(Contrast Enhanced Ratio,CER)。
采用双盲法对垂体微腺瘤检出分级的评定方法如下:I级垂体腺未见异常信号灶;II级垂体微腺瘤,境界不清;III级垂体微腺瘤,境界清楚。I级为病灶检出阴性,II、III级为病灶检出阳性。
使用SAS8.0软件,以t检验和χ2检验对统计结果进行分析。
结果
1对感兴趣区分别测量垂体柄、正常垂体腺前叶、垂体微腺瘤三者的峰值、强化率及三者间比较如下:
1.1正常垂体柄强化峰值见于29.32±15.89s,垂体柄峰值的强化率为平扫时的149.72±61.47%。
1.2正常垂体腺前叶强化峰值较垂体柄的强化峰值出现晚,见于58.32±22.40s,正常腺前叶峰值的强化率较垂体柄的高,为218.25±56.87%。垂体柄和正常垂体腺前叶的强化峰值的出现和强化比率的差异均具有统计学意义(P<0.01)。
1.3垂体微腺瘤一般在平扫及动态增强早期为低信号灶,垂体微腺瘤的强化峰值较正常垂体腺前叶强化出现晚,见于103.89±25.38s,垂体微腺瘤的强化比率亦较正常垂体腺前叶低,为163.32±77.35%。正常垂体腺前叶与垂体微腺瘤的峰值出现时间和强化比率的差异均具有统计学意义(P <0.01)。
2正常垂体腺前叶和垂体微腺瘤的最大对比见于71.04±24.09s,最大对比度为46.71±11.86%。
3本组28个病例中,平扫对垂体微腺瘤的检出率为32.14%(9/28),动态增强对垂体微腺瘤的检出率为82.14%(23/28),常规增强扫描对垂体微腺瘤的检出率为57.14%(16/28)。平扫与动态增强对垂体微腺瘤的检出率间有统计学意义(P <0.05);动态增强与常规增强扫描对垂体微腺瘤的检出率间无统计学意义(P >0.05)。
结论
1动态增强早期对垂体微腺瘤的检出很关键,即静脉注入Gd-DTPA对比剂后立即扫描,垂体微腺瘤就易检出。
2动态增强早期时相,垂体微腺瘤与周围正常垂体组织间的对比度较大,显示病灶效果最佳。
3动态增强早期对病灶的检出率最高,常规增强能够作为动态增强的补充,如果两者联合应用能够对病灶的检出率更高,而不致造成漏诊。
Objective:Through analyzsing the three time-signal intensity curves of the stalk, the normal pituitary gland anterior lobe and the pituitary microadenoma, And the time-enhancement curve of the normal pituitary gland anterior lobe and the pituitary gland microadenoma. And appraise the technology of dynamic contrast-enhanced 1.5T MRI to detection rate of the pituitary gland microadenoma .
Material and methods:Collection the source Shanghai Jiaotong University Suzhou Kowloon Hospital,from January, 2008 to December 28 patients,Female 24,Men 4,Age 13～77 years old (average age 27.76±12.35 years old),Apply Siemens Magnetom Anvato, 1.5T superconductivity magnetic resonance scanner .
Using Mean Curve software analysis,Put the interest of review (ROI) 0.1mm2 in the stalk, the normal pituitary gland anterior lobe, the pituitary gland microadenoma and the skull external noise area, separately. Obtain time-signal intensity curve separately. And analysis strengthening peak value. Calculate the Contrast Enhanced Ratio of strengthening peak value and the signal intensity of interest area .
Uses double picking out the graduation to the pituitary gland microadenoma blindly and the evaluation method to be as follows:I Pituitary gland has not seen the unusual signal. II The pituitary gland microadenoma boundary is unclear. III The pituitary gland microadenoma is clear.The I level is negative and the II、III level is posative .
Apply the SAS8.0 software,Aanalysis by the T-test and theχ2-tese to the statistical result .
Results:
1 Pituitary salk,anterior pituitary,pituitary microadenomas three peaks,enhanced rate and among the there are as follows:
1.1 Normal pituitary stalk enhanced peak at 29.32±15.89s,The strengtren-ratio of pituitary stalk to it’s plain’s is 149.72±61.47%.
1.2 The enhanced-peak of anterior pituitary is later than the pituitary stalk,s,at 58.32±22.40s,The strengtren-ratio of anterior pituitary is higher than the pituitary stalk’s,at 218.25±56.87%,The differences of the ehanced-peak and strengtren-ratio between the pituitary stalk and anterior pituitary are statistically significant(P<0.01). 1.3 The both of pituitary microadenomas generally plaining and dynamic contrast-enhanced scanning show low signal, The enhanced-peak of pituitary microadenomas is later than the normal pituitary gland’s,at 103.89±25.38s,The strengtren-ratio of pituitary microadenomas is also lower than the normal pituitary gland,s,at 163.32±77.35%. The differences between the ehanced-peak and strengtren-ratio of anterior pituitary and pituitary microadenomas are statistically significant(P<0.01).
2 Betwwen the largest seening contrast of anterior pituitary and pituitary microadenomas is at 71.04±24.09s,the greatest contrast to 46.71±11.86%.
3 This group 28 cases,The plain detecting the rate of pituitary microadenomas is 32.14%(9/28),dynamic enhancement showing the rate is 82.14%(23/28),conventional enhanced scan showing the rate 57.14%.The detection rate of pituitary microadenomas between plain and dynamic contrast-enhanced scan is statistically significant (P<0.05). The detecting rate of pituitary microadenomas between dynamic contras-enhanced and conventional enhancement has no statistically significance(P>0.05).
Conclusion:1 It is very essential that the dynamic contrast-enhancement picks out the pituitary gland microadenoma at early time. After namely the vein poured into the Gd-DTPA contrast agent, scanning immediately, the pituitary gland microadenoma is easy to pick out.
2 At the dynamic contrast-enhanced early time phase,The contrast gradient between the pituitary gland microadenoma and the normal pituitary gland organization is more obvious. Demonstrating the effect of lesion is best .
3 The dynamic contrast-enhanced detecting the lesion is the highest rate at early time.The conventiontional enhancement scan takes the dynamic contrast-enhanced supplement. If both union application can be higher detecting rate, but does not create leaking lesions.
引文
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2 Elster AD.Modern imaging of the pituitary.Radiology , 1993,187 (1) :1﹣14.沈天真,陈星荣.
3中枢神经系统计算机体层摄影和磁共振成像.第一版上海:海医科大学出版社,1992.
4尹建忠,译.MRI:基础.天津科技翻译出版公司,2004:252.
5 Sakamoto Y,Takahashi M,Korogi Y et al.Normal and abnormal pituitary glands:gadopentetate dimeglumine-enhanced MR imaging.Radiology ,1991,178:441﹣445.
6 Aron DC,Findling JW,Tyrell JB.Hypothalamus and pituitary.In:Greenspan FS,Strewler GJ,eds.Basic and Clinnical Endocrinology [M].5th edition. Stamford:Appleton and Lange,1997,95﹣156.
7王守森,张发惠,章翔,等.垂体的解剖及其临床意义.国外医学神经病学外科学分册,2000.,27(5):225﹣228.
8蒋海清,等.垂体微腺瘤的MRI诊断与鉴别诊断.中国临床医生杂志,2007,35(8):69﹣70.
9 Tien RD.Sequence of enhancement of various portions of the pituitary gland on gadolinium-enhanced MR image:correlation with regional blood supply.AJR,1992,158(3):651﹣654.
10 Chandler WF,et al.Surgical treatment of Cushing,s disease.J Neurosurg,1987,66(2):204.
11张云燕,等.垂体瘤的影像学表现.中国医学影像技术,1996,12(5):382﹣384.
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2沈天真,陈星荣.中枢神经系统计算机体层摄影和磁共振成像.第一版上海:海医科大学出版社,1992.
3 Aron DC,Findling JW,Tyrell JB.Hypothalamus and pituitary.In:Greenspan FS,Strewler GJ,eds.Basic and Clinnical Endocrinology [M].5th edition. Stamford:Appleton and Lange,1997,95﹣156.
4王守森,张发惠,章翔,等.垂体的解剖及其临床意义.国外医学神经病学外科学分册,2000.,27(5):225﹣228.
5蒋海清,等.垂体微腺瘤的MRI诊断与鉴别诊断.中国临床医生杂志,2007,35(8):69﹣70.
6坂本佑二他,画像诊断,1992,12(1):29﹣35.
7 Tien RD.Sequence of enhancement of various portions of the pituitary gland on gadolinium-enhanced MR image:correlation with regional blood supply.AJR,1992,158(3):651﹣654.
8 Sakamoto Y , et al . Normal and abnormal pituitary glands : gadopentetate dimeglumine-enhanced MR imaging.Radiology,1991,178(2):441﹣445.
9 Hermen V,et al.Adv Biosci,1988,69:77.
10 Chandler WF,et al.Surgical treatment of Cushing,s disease.J Neurosurg,1987,66(2):204.
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27尹建忠,译.MRI:基础.天津科技翻译出版公司,2004:252.
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31姜新雅,等.垂体微腺瘤动态增强MRI的临床应用.中国现代医学杂志,2005,15(11):1715﹣1717.
32任永芳,等.垂体微腺瘤不同增强方式MRI的诊断价值.放射学实践,2005,20(1):18﹣20.
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2 Elster AD.Modern imaging of the pituitary.Radiology , 1993,187 (1) :1﹣14.沈天真,陈星荣.
3中枢神经系统计算机体层摄影和磁共振成像.第一版上海:海医科大学出版社,1992.
4尹建忠,译.MRI:基础.天津科技翻译出版公司,2004:252.
5 Sakamoto Y,Takahashi M,Korogi Y et al.Normal and abnormal pituitary glands:gadopentetate dimeglumine-enhanced MR imaging.Radiology ,1991,178:441﹣445.
6 Aron DC,Findling JW,Tyrell JB.Hypothalamus and pituitary.In:Greenspan FS,Strewler GJ,eds.Basic and Clinnical Endocrinology [M].5th edition. Stamford:Appleton and Lange,1997,95﹣156.
7王守森,张发惠,章翔,等.垂体的解剖及其临床意义.国外医学神经病学外科学分册,2000.,27(5):225﹣228.
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