Peck W W, Dillon W P, Norman D, Newton T H, Wilson C B
Department of Radiology, University of California, San Francisco 94143.
AJR Am J Roentgenol. 1989 Jan;152(1):145-51. doi: 10.2214/ajr.152.1.145.
The MR images of 27 patients with clinically and biochemically suspected Cushing disease were evaluated retrospectively in a blinded fashion. The MR interpretation was compared with detailed operative diagrams and operative and pathologic reports. The examinations were performed on a 1.5-T MR system with thin-section sagittal and coronal T1-weighted (short TR/TE) images. Each pituitary half was considered separately (54 "halves"). Twenty-one pituitary halves were considered to have glandular abnormalities on MR. Compared with surgical findings, 17 MR findings were true positives and four were false positives (one pars intermedia cyst, three normal tissue). Of the 33 pituitary halves considered normal on MR, 26 were true negatives and seven were false negatives. MR had an overall sensitivity of 71% and a specificity of 87% for these adrenocorticotropic hormone (ACTH)-secreting pituitary adenomas. A focal glandular hypointensity identified on coronal images was the most sensitive predictor of adenoma location. Sagittal images were not useful in either detection or localization. Upward convexity of the gland and deviation of the stalk were less useful indicators. Abnormalities of the sellar floor were the least reliable. In comparison with the capabilities of CT detection of microadenomas described in the current literature, it appears that high-field thin-section MR of the sella is the most sensitive imaging method for preoperative localization of ACTH-secreting adenomas in patients with Cushing disease.
对27例临床及生化检查怀疑患有库欣病的患者的磁共振成像（MR）进行回顾性、盲法评估。将MR诊断结果与详细的手术示意图、手术及病理报告进行比较。检查在1.5-T MR系统上进行，采用薄层矢状位和冠状位T1加权（短TR/TE）图像。每个垂体半叶单独评估（共54个“半叶”）。21个垂体半叶在MR上被认为存在腺性异常。与手术结果相比，17个MR结果为真阳性，4个为假阳性（1个中间部囊肿，3个正常组织）。在MR上被认为正常的33个垂体半叶中，26个为真阴性，7个为假阴性。对于这些分泌促肾上腺皮质激素（ACTH）的垂体腺瘤，MR的总体敏感性为71%，特异性为87%。冠状位图像上发现的局灶性腺性低信号是腺瘤位置最敏感的预测指标。矢状位图像在检测或定位方面均无帮助。垂体向上凸起和垂体柄偏移的指示作用较小。鞍底异常是最不可靠的。与当前文献中描述的CT检测微腺瘤的能力相比，对于库欣病患者分泌ACTH腺瘤的术前定位，蝶鞍的高场薄层MR似乎是最敏感的成像方法。
