Taylor S L, Barakos J A, Harsh G R, Wilson C B
Department of Neurological Surgery, School of Medicine, University of California, San Francisco.
Neurosurgery. 1992 Oct;31(4):621-7; discussion 627. doi: 10.1227/00006123-199210000-00002.
Despite recent advances in neurodiagnostic imaging, it may be difficult to differentiate tuberculum sellae meningiomas from pituitary macroadenomas preoperatively. Magnetic resonance (MR) imaging has supplanted computed tomography as the imaging modality of choice for sellar and parasellar lesions, but unenhanced MR imaging does not reliably distinguish between all tuberculum sellae meningiomas and pituitary macroadenomas. Accurate differentiation between these alternative diagnoses of a suprasellar mass is important because a tuberculum sellae meningioma always requires a craniotomy, whereas a transsphenoidal route is preferred for removing most pituitary macroadenomas. The gadolinium-enhanced MR images of seven patients with tuberculum sellae meningioma and seven with pituitary macroadenoma were reviewed retrospectively. Although no specific radiological feature was pathognomonic, a combination of several features allowed the correct diagnosis in all cases. Three characteristics of tuberculum sellae meningiomas distinguish them from pituitary macroadenomas: 1) bright homogeneous enhancement with gadolinium, as opposed to heterogeneous, relatively poor enhancement; 2) a suprasellar rather than a sellar epicenter of tumor; and 3) tapered extension of an intracranial dural base. Each of these findings can be subtle, but careful examination of gadolinium-enhanced, high-quality, thin section coronal and sagittal MR images of the parasellar region for this constellation of findings will allow the correct preoperative diagnosis in patients with either of these tumors.
尽管神经诊断成像技术最近取得了进展，但术前区分鞍结节脑膜瘤和垂体大腺瘤可能仍有困难。磁共振（MR）成像已取代计算机断层扫描，成为鞍区和鞍旁病变的首选成像方式，但未增强的MR成像并不能可靠地区分所有鞍结节脑膜瘤和垂体大腺瘤。准确区分鞍上肿块的这些不同诊断很重要，因为鞍结节脑膜瘤总是需要开颅手术，而大多数垂体大腺瘤则首选经蝶窦途径切除。回顾性分析了7例鞍结节脑膜瘤患者和7例垂体大腺瘤患者的钆增强MR图像。虽然没有特定的放射学特征具有诊断特异性，但几种特征的组合在所有病例中都能做出正确诊断。鞍结节脑膜瘤与垂体大腺瘤的三个特征区别如下：1）钆增强后呈均匀明亮强化，而非不均匀、强化相对较差；2）肿瘤的中心位于鞍上而非鞍内；3）颅内硬脑膜基底呈锥形延伸。这些发现中的每一个都可能很细微，但仔细检查鞍旁区域钆增强、高质量、薄层冠状位和矢状位MR图像中是否存在这一系列表现，将有助于对患有这两种肿瘤之一的患者做出正确的术前诊断。
