垂体腺瘤伴发Rathke裂囊肿的临床和MRI特点  

Clinical and MRI features of pituitary adenomas accompanied by Rathke's cleft cyst

作　　者：吴志峰[1] 钟群[2] 徐晓芳[3] 王守森[4] 

机构地区：[1]第二军医大学福州临床学院神经外科,福建福州350003 [2]南京军区福州总医院医学影像中心,福建福州350025 [3]南京军区福州总医院病理科,福建福州350025 [4]南京军区福州总医院神经外科,福建福州350025

出　　处：《中华神经外科疾病研究杂志》2016年第3期246-249,共4页Chinese Journal of Neurosurgical Disease Research

基　　金：南京军区十二五医学创新重点基金资助项目(2011Z034);福州总医院创新团队基金资助项目(2014-07)

摘　　要：目的探讨垂体腺瘤伴发Rathke裂囊肿(RCC)的临床表现和MRI特点,提高对病变的认识。方法对连续收治的8例垂体腺瘤伴发RCC患者的临床表现、MRI资料进行回顾性分析。8例患者中,临床表现主要有头痛、视力下降及垂体激素分泌紊乱的症状;1例患者在体检中偶然发现。MRI表现有:1鞍区内存在两种病变,往往以肿瘤成分为主,伴发1个甚至多个的RCC;2边界清晰,主体位于鞍内,可向鞍上生长;3垂体腺瘤T_1WI呈等或低信号,T_2WI呈高信号;囊腔T_1WI主要呈低信号,T_2WI信号多样化;4部分囊腔内可见T_1WI等信号,T_2WI低信号的囊内结节;5增强扫描,垂体腺瘤呈不同程度的强化,囊壁多数不强化。结果随访4个月至7年,术后头痛、视力下降及内分泌紊乱症状均得到改善。1例垂体腺瘤有残留需二期手术,1例于术后7年复发。结论垂体腺瘤伴发RCC的患者,常缺乏RCC的特异性表现;如MRI示鞍区病变为囊实性,且其主体位于鞍内、囊腔信号均匀、囊壁不强化,应考虑到垂体腺瘤伴发RCC的可能性,若囊内存在结节,则具有诊断意义。经蝶手术为治疗首选,术后需定期随访。Objective The clinical features and magnetic resonance （MR） imaging finding of pituitary adenomas accompanied by Rathkes cleft cyst （RCC） are investigated. Methods The clinical data and MR imaging findings of 8 patients with pituitary adenomas accompanied by RCC were analyzed retrospectively. Among 8 patients with pituitary adenomas accompanied by RCC, 7 patients presented with correspondent clinical symptoms, including visual disturbances, headache and hormonal symptoms, and 1 patient had no symptom. There were some MRI features for pituitary adenomas accompanied by RCC： there were often two kinds of lesions in saddle area, including tumor components and 1 or more RCC; the boundary was clear, the main body was located in the saddle, and it can grow on the saddle; pituitary adenomas often showed isointense or hypointense on T1-weighted images and hyperintense on T2- weighted images; RCC often showed hypointense on T1-weighted images, while the signal intensity on T2-weighted images were diverse; an intracystic nodule showed isointense on T1-weighted images, and hypointense on T2-weighted images was observed in some patients; pituitary adenomas showed various degrees of enhancement, but RCC did not show enhancement. Results The patients have been followed up for 4 months to 7 years. Headache and visual disturbance had got improved. One patient had residual tumor and another patient had recurrence of RCC after transsphenoidal operation. Conclusion Clinical manifestations of pituitary adenomas accompanied by RCC are not specific. When a non-enhancing cyst-like structure is demonstrated on imaging in a patient with a pituitary adenoma, the possibility of a coexisting Rathkes cleft cyst should be considered. Intracystic nodule is helpful in the differential diagnosis. The transsphenoidal operation is the primary choice and the regular follow-up should be carried out after surgery.

关 键 词：垂体腺瘤 RATHKE裂囊肿 磁共振成像 

分 类 号：R736.4[医药卫生—肿瘤]