Hwang Jisun, Jo Sang Won, Kwon Eun Byul, Lee Seun Ah, Chang Suk-Ki
Department of Radiology, Dongtan Sacred Heart Hospital, Hallym University Medical Center, 7, Keunjaebong-gil, Hwaseong-si, Gyeonggi-do, 18450, Republic of Korea.
Department of Pediatrics, Dongtan Sacred Heart Hospital, Hallym University Medical Center, 7, Keunjaebong-gil, Hwaseong-si, Gyeonggi-do, 18450, Republic of Korea.
Neuroradiology. 2021 Jul;63(7):1121-1133. doi: 10.1007/s00234-021-02665-3. Epub 2021 Feb 20.
To verify and integrate the prevalence and phenotype of abnormalities in the sellar region in patients with growth hormone deficiency (GHD) using MRI data.
We searched PubMed and EMBASE up to December 14, 2020. The inclusion criteria were as follows: (1) pediatric patients diagnosed with nonacquired GHD and (2) detailed data sufficient to assess the proportion of sellar and parasellar abnormalities on brain MRI scans. Finally, thirty-two studies with 39,060 children (mean or median age, 3.4-14.1 years) were included. The number and type of MRI findings from all included studies were pooled by two authors. The heterogeneity across studies was evaluated with the Q test or the inconsistency index (I) statistic. Subgroup analyses were performed according to the type of GHD (isolated GHD [IGHD] vs. multiple pituitary hormone deficiency [MPHD]), MRI magnet, geographical region, and cutoff serum growth hormone (GH) level.
The pooled proportion of sellar and parasellar abnormalities was 58.0% (95% CI, 47.1-68.6%; I, 98.2%). The MPHD group showed a higher proportion of sellar and parasellar abnormalities and pituitary stalk interruption syndrome than the IGHD group (91.4% vs. 40.1%, P<0.001; 65.3% vs. 20.1%, P<0.001). The patients in studies with low peak GH levels on stimulation tests were more associated with severe MR abnormalities (cutoff GH ≤ 5 μg/l vs. cutoff GH = 10 μg/l; 72.8 % vs. 38.0%; P<0.001).
The types and incidence of MRI abnormalities of the sellar region differ significantly between the IGHD and MPHD groups.
利用磁共振成像（MRI）数据验证并整合生长激素缺乏症（GHD）患者蝶鞍区异常的患病率及表型。
检索截至2020年12月14日的PubMed和EMBASE。纳入标准如下：（1）诊断为非获得性GHD的儿科患者；（2）有足够详细的数据以评估脑部MRI扫描中蝶鞍和鞍旁异常的比例。最终纳入32项研究，共39,060名儿童（平均或中位年龄3.4 - 14.1岁）。由两位作者汇总所有纳入研究的MRI检查结果的数量和类型。采用Q检验或不一致指数（I）统计量评估研究间的异质性。根据GHD类型（孤立性生长激素缺乏症[IGHD]与多种垂体激素缺乏症[MPHD]）、MRI磁体、地理区域以及血清生长激素（GH）水平临界值进行亚组分析。
蝶鞍和鞍旁异常的汇总比例为58.0%（95%可信区间，47.1 - 68.6%；I，98.2%）。MPHD组蝶鞍和鞍旁异常以及垂体柄中断综合征的比例高于IGHD组（91.4%对40.1%，P<0.001；65.3%对20.1%，P<0.001）。刺激试验中GH峰值水平低的研究中的患者与严重MR异常的相关性更高（GH临界值≤5μg/L对GH临界值 = 10μg/L；72.8%对38.0%；P<0.001）。
IGHD组和MPHD组蝶鞍区MRI异常的类型和发生率存在显著差异。
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