Adams N C, Farrell T P, O'Shea A, O'Hare A, Thornton J, Power S, Brennan P, Looby S
Department of Neuroradiology, Beaumont Hospital, Dublin 9, Ireland.
Neuroradiology. 2018 Oct;60(10):995-1012. doi: 10.1007/s00234-018-2072-7. Epub 2018 Aug 10.
Central or neurogenic diabetes insipidus (CDI) is due to deficient synthesis or secretion of antidiuretic hormone (ADH), also known as arginine vasopressin peptide (AVP). It is clinically characterised by polydipsia and polyuria (urine output > 30 mL/kg/day) of dilute urine (< 250 mOsm/L). It is the result of a defect in one of more sites involving the hypothalamic osmoreceptors, supraoptic or paraventricular nuclei of the hypothalamus, median eminence of the hypothalamus, infundibulum or the posterior pituitary gland. A focused MRI pituitary gland or sella protocol is essential. There are several neuroimaging correlates and causes of CDI, illustrated in this review. The most common causes are benign or malignant neoplasms of the hypothalamic-pituitary axis (25%), surgery (20%), head trauma (16%) or familial causes (10%). No cause is identified in up to 30% of cases. Knowledge of the anatomy and physiology of the hypothalamo-neurohypophyseal axis is crucial when evaluating a patient with CDI. Establishing the aetiology of CDI with MRI in combination with clinical and biochemical assessment facilitates appropriate targeted treatment. The aim of the pictorial review is to illustrate the wide variety of causes of CDI on neuroimaging, highlight the optimal MRI protocol and to revise the detailed neuroanatomy and neurophysiology required to interpret these studies.
中枢性或神经源性尿崩症（CDI）是由于抗利尿激素（ADH）合成或分泌不足所致，抗利尿激素也称为精氨酸加压素肽（AVP）。其临床特征为烦渴和多尿（尿量>30 mL/kg/天），尿液稀释（<250 mOsm/L）。它是下丘脑渗透压感受器、下丘脑视上核或室旁核、下丘脑正中隆起、漏斗或垂体后叶中一个或多个部位存在缺陷的结果。重点进行垂体或蝶鞍的MRI检查至关重要。本综述阐述了CDI的几种神经影像学相关表现及病因。最常见的病因是下丘脑-垂体轴的良性或恶性肿瘤（25%）、手术（20%）、头部创伤（16%）或家族性病因（10%）。高达30%的病例未发现病因。在评估CDI患者时，了解下丘脑-神经垂体轴的解剖和生理知识至关重要。通过MRI结合临床和生化评估来确定CDI的病因有助于进行适当的靶向治疗。本图文综述的目的是阐明神经影像学上CDI的多种病因，强调最佳MRI检查方案，并复习解读这些检查所需的详细神经解剖学和神经生理学知识。
