磁共振成像、术中探查和病理在侵袭性垂体腺瘤诊断中的作用  

Roles of MRI, intraoperative exploration and pathology in diagnosis of invasive pituitary adenoma

作　　者：位振清[1] 王任直[1] 姚勇[1] 邓侃[1] 王剑新[1] 肖健齐[1] 焦永辉[1] 孙博文[1] 左赋兴[1] 孙健[2] 

机构地区：[1]中国医学科学院北京协和医院神经外科,100730 [2]中国医学科学院北京协和医院病理科,100730

出　　处：《中华神经外科杂志》2014年第10期1019-1022,共4页Chinese Journal of Neurosurgery

基　　金：基金项目：首都卫生发展基金（首发2011-4001-06）

摘　　要：目的 探讨磁共振成像（MRI）、术中探查和病理在侵袭性垂体腺瘤中的诊断作用。方法 分析125例向海绵窦生长的垂体腺瘤患者的MRI、手术和病理临床资料,分别以MRI、术中探查和病理为标准来确定其侵袭性并分组.MRI组以Knosp-Steiner分级Ⅲ或Ⅳ级为标准;手术组以术中观察海绵窦内侧壁有穿孔或破损为标准;病理组以Ki-67标记指数＞3％为标准,并行相关统计分析。结果 MRI组：104例判定为侵袭性垂体腺瘤;手术组：92例判定为侵袭性垂体腺瘤;病理组：14例判定为侵袭性垂体腺瘤,三组比较差异有统计学意义（P=0.000）;病理组与手术组比较、病理组与MRI组比较差异有统计学意义（P=0.000,P=0.000）,MRI组与手术组比较差异无统计学意义（P＞0.05）.MRI具有良好的诊断价值（灵敏度100％,特异度63.6％,阳性预测值88.5％,阴性预测值100％）,准确性明显高于病理（灵敏度20.7％,特异度84.8％,阳性预测值79.2％,阴性预测值27.7％）。结论 在垂体腺瘤的侵袭性诊断上,MRI及术中探查明显较病理学具有更高的准确率。Objective To study the roles of MRI,intraoperative exploration and pathology in the diagnosis of invasive pituitary adenoma（IPA）.Methods An analysis of the clinical data of MRI,surgery and pathology was taken in 125 cases of pituitary adenoma with the growth towards cavernous sinus,to determine their invasiveness and to group them respectively on the basis of MRI,intraoperative exploration and pathology.MRI group：Knosp-Steiner grading scales Ⅲ or Ⅳ as a inclusion criteria for IPA; Operation group：a hole or worn discovered in medial wall of the cavernous sinus by intraoperative observation as a criteria; Pathology group：Ki-67 labeling index 〉 3% as a criteria.The relevant statistical analysis was performed on them.Results MRI group：104 cases were identified as IPA.Operation group：92 cases were determined.Pathology group：14 cases were defined as IPA.The three groups were significantly different in determining IPA （P =0.000）,and the pathology group compared with the operation and MRI groups respectively were also significantly different （P =0.000,P =0.000,respectively）,whereas the comparision between the MRI and operation group was not significantly different（P 〉 0.05）.MRIdemonstrated good diagnostic value on IPA （sensitivity 100%,specificity 63.6%,positive predictive value 88.5%,negative predictive value 100%） and had obviously higher accuracy than pathology（sensitivity 20.7%,specificity84.8%,positive predictive value 79.2%,negative predictive value 27.7%）.Conclusions In the diagnosis of IPA,MRIand intraoperative exploration had higher accuracy than pathology.

关 键 词：垂体腺瘤 肿瘤侵润 磁共振成像 病理学 神经外科手术 

分 类 号：R736.4[医药卫生—肿瘤]