腺垂体体积测量在女童性早熟中的鉴别诊断价值  

The diagnostic value of adenohypophysis volume measurement in central precocious puberty for girls

作　　者：丁国峻 刘栋 蔡坚坚 张佳璇 赵云云 DING Guo-jun;LIU Dong;CAI Jian-jian(Department of Radiology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院放射科,武汉430030

出　　处：《放射学实践》2023年第11期1368-1373,共6页Radiologic Practice

基　　金：国家自然科学基金青年项目(82001787);湖北省自然科学基金面上项目(2023AFB862)。

摘　　要：目的:探究磁共振3D CUBE T_(1)WI测量腺垂体体积对女童性早熟的鉴别诊断价值,为临床性早熟患者提供非侵入性和替代性的诊断方法。方法:纳入2020年5月-2022年7月华中科技大学同济医学院附属同济医院就诊的128名性早熟女童,根据临床诊断及促性腺激素释放激素(GnRH)激发试验分为两组:中枢性性早熟(CPP)组57例,单纯乳房早发育(PT)组71例。所有病例均接受垂体MRI 3D CUBE T_(1)扫描及GnRH激发试验。收集并测量腺垂体特征(高度及测量体积)、临床特征及血清学指标。采用单因素方差分析方法分析各参数间之间差异;Pearson相关分析探究垂体体积与激发实验结果及血清学指标之间的相关性,并采用ROC曲线分析腺垂体高度及测量体积对不同类型性早熟患者的鉴别诊断价值。结果:CPP组腺垂体高度(aPH)及体积(aPV)均显著性高于PT组(P均<0.001);aPV与LH/FSH、LH基础值及血清E2表达水平呈高度正相关(P<0.001);aPV与LH峰值、FSH基础值、IGF-1、IGFBP-3表达水平呈中度正相关;aPV与血清COR表达水平呈中度负相关;ROC曲线分析表明,aPV在鉴别诊断CPP与PT的诊断效能高于aPH具有显著性差异,aPV的AUC(0.879,95%CI:0.810~0.930)高于aPH的AUC(0.755,95%CI:0.671~0.827),P=0.0183。aPV鉴别诊断两种不同类型性早熟患者的敏感度(95.27%)及阳性预测率(91.1%)远高于aPH。结论:本研究发现磁共振3D CUBE T_(1)WI序列所得腺垂体体积可有效地鉴别中枢性性早熟与单纯乳房早发育。对腺垂体体积的评估有可能成为一种无创性诊断中枢性性早熟的方法。Objective:To explore the diagnostic value of adenohypophysis volume(aPV)measured by MRI 3D CUBE T_(1)sequence in central precocious puberty(CPP),and to provide non-invasive and alternative diagnostic methods for precocious puberty patients.Methods:A total of 128 girls with precocious puberty who were admitted to Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from May 2020 to July 2022 were enrolled and divided into two groups according to clinical diagnosis and gonadotropin-releasing hormone(GnRH)challenge test:CPP group with 57 cases,premature thelarche(PT)group with 71 cases.All patients underwent 3D CUBE T_(1)sequence scan and GnRH stimulation test.The MR characteristics(aPH and aPV),clinical features and serological results were collected and measured.One-way analysis of variance was used to analyze the differences among the parameters.Pearson correlation analysis was used to explore the correlation between aPV,stimulation test and serological results,and ROC curve was used to analyze the differential diagnosis value of aPH and aPV in patients with different types of precocious puberty.Results:aPH and aPV in CPP group were significantly higher than those in PT group(all P<0.001).aPV was highly positively correlated with LH/FSH,basal LH and serum E2 expression level(P<0.001).There was a moderate positive correlation with the peak LH,basal FSH,IGF-1 and IGFBP-3 expression levels.It was negatively correlated with serum COR expression level.ROC curve analysis showed that the diagnostic performance of aPV was significantly higher than that of aPH in identifying CPP and PT,and the AUC of aPV was higher than that of aPH(0.879 vs.0.755,P=0.0183).The sensitivity(95.27%)and positive prediction rate(91.1%)of aPV were much higher than those of aPH.Conclusion:This study found that the adenohypophysis volume measured by 3D CUBE T_(1)WI sequence could effectively distinguish CPP from PT.The assessment of aPV with 3D CUBE T_(1)WI sequence may be a noninvasive method for

关 键 词：磁共振成像 中枢性性早熟 腺垂体体积 GnRH刺激试验 

分 类 号：R445.2[医药卫生—影像医学与核医学] R742.89[医药卫生—诊断学]