多巴胺激动剂治疗抵抗的催乳素瘤的动态磁共振成像增强特征
Characteristics of dynamic magnetic resonance image enhancement in prolactinomas resistant to dopamine agonist therapy.
作者信息
Guo Qinghua, Erickson Bradley J, Chang Alice Y, Erickson Dana
机构信息
From the *Division of Endocrinology, Chinese PLA General Hospital, Beijing, China; and †Department of Radiology and ‡Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN.
出版信息
J Investig Med. 2015 Mar;63(3):529-33. doi: 10.1097/JIM.0000000000000138.
OBJECTIVE
The objective of this study was to determine whether dynamic magnetic resonance imaging (dMRI) enhancement parameters could predict dopamine agonist (DA) resistance in prolactinomas.
METHODS
We retrospectively identified patients with prolactinomas who were treated with DA and underwent dMRI from 2001 through 2012 at Mayo Clinic (Rochester, MN). Intensities of the adenoma and pituitary gland were measured by drawing regions of interest on the images. Enhancement ratio, enhancement peak, prepeak slope (PPS), and enhancement time were compared between DA-resistant and DA-responsive groups, between DA-treated and DA-naive groups, and between the first and follow-up dMRIs.
RESULTS
We identified 49 patients with prolactinomas, with 6 (12.2%) showing DA resistance. Thirty-seven patients (75.5%) underwent dMRI while receiving treatment, 12 (25.5%) underwent dMRI before starting therapy, and 10 (20.4%) had follow-up dMRI after DA therapy. The PPS of the tumor was higher in the treatment-resistant group versus the responsive group (mean [SD], 4.42 [3.19] vs 2.65 [1.59]; P = 0.03), whereas no difference was noted in the pituitary gland (5.79 [2.21] vs 4.06 [2.48]; P = 0.11). Logistic regression analysis indicated that tumor PPS was associated with DA resistance (odds ratio, 1.71; 95% confidence interval, 1.07-3.27; P = 0.02).
CONCLUSIONS
Dynamic MRI with PPS analysis potentially can be used early in the treatment course to evaluate DA resistance in pituitary prolactinomas.
目的
本研究的目的是确定动态磁共振成像（dMRI）增强参数是否能够预测泌乳素瘤对多巴胺激动剂（DA）的抵抗性。
方法
我们回顾性纳入了2001年至2012年在梅奥诊所（明尼苏达州罗切斯特）接受DA治疗并接受dMRI检查的泌乳素瘤患者。通过在图像上绘制感兴趣区域来测量腺瘤和垂体的强度。比较了DA抵抗组和DA反应组、DA治疗组和未接受DA治疗组以及首次和随访dMRI之间的增强率、增强峰值、峰前斜率（PPS）和增强时间。
结果
我们确定了49例泌乳素瘤患者，其中6例（12.2%）表现出DA抵抗。37例患者（75.5%）在接受治疗时接受了dMRI检查，12例（25.5%）在开始治疗前接受了dMRI检查，10例（20.4%）在DA治疗后进行了随访dMRI检查。治疗抵抗组肿瘤的PPS高于反应组（均值[标准差]，4.42[3.19]对2.65[1.59]；P = 0.03），而垂体的PPS无差异（5.79[2.21]对4.06[2.48]；P = 0.11）。逻辑回归分析表明，肿瘤PPS与DA抵抗相关（比值比，1.71；95%置信区间，1.07 - 3.27；P = 0.02）。
结论
采用PPS分析的动态MRI有可能在治疗过程早期用于评估垂体泌乳素瘤的DA抵抗性。
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