Boellis Alessandro, di Napoli Alberto, Romano Andrea, Bozzao Alessandro
Neuroradiology NESMOS Department, University of Rome "La Sapienza" and Azienda Ospedaliera Sant'Andrea, Via di Grottarossa, 1035/1039, Rome, Italy,
Insights Imaging. 2014 Dec;5(6):753-62. doi: 10.1007/s13244-014-0362-0. Epub 2014 Oct 16.
Pituitary apoplexy (PA) is a rare and potentially fatal clinical condition presenting acute headache, vomiting, visual impairment, ophthalmoplegia, altered mental state and possible panhypopituitarism. It mostly occurs in patients with haemorrhagic infarction of the pituitary gland due to a pre-existing macroadenoma. Although there are pathological and physiological conditions that may share similar imaging characteristics, both clinical and imaging features can guide the radiologist towards the correct diagnosis, especially using magnetic resonance imaging (MRI). In this review, we will describe the main clinical and epidemiological features of PA, illustrating CT and MRI findings and discussing the role of imaging in the differential diagnosis, prognosis and follow-up. Teaching points • Headache, ophtalmoplegia and visual impairment are frequent symptoms of pituitary apoplexy. • CT is often the first imaging tool in PA, showing areas of hyperdensity within the sellar region. • MRI could confirm haemorrhage within the pituitary gland and compression on the optic chiasm. • Frequent simulating conditions are aneurysms, Rathke cleft cysts, craniopharingioma and mucocele. • The role of imaging is still debated and needs more studies.
垂体卒中（PA）是一种罕见且可能致命的临床病症，表现为急性头痛、呕吐、视力障碍、眼肌麻痹、精神状态改变以及可能出现的全垂体功能减退。它大多发生于因先前存在的大腺瘤导致垂体出血性梗死的患者。尽管存在一些可能具有相似影像学特征的病理和生理状况，但临床和影像学特征均可引导放射科医生做出正确诊断，尤其是使用磁共振成像（MRI）时。在本综述中，我们将描述垂体卒中的主要临床和流行病学特征，阐述CT和MRI表现，并讨论影像学在鉴别诊断、预后及随访中的作用。教学要点 • 头痛、眼肌麻痹和视力障碍是垂体卒中的常见症状。 • CT通常是垂体卒中的首选影像学检查工具，显示鞍区内的高密度区域。 • MRI可确认垂体出血及对视交叉的压迫。 • 常见的相似病症有动脉瘤、拉克氏囊肿、颅咽管瘤和黏液囊肿。 • 影像学的作用仍存在争议，需要更多研究。
