Buchfelder M, Nistor R, Fahlbusch R, Huk W J
Neurochirurgische Klinik mit Poliklinik, Universität Erlangen-Nürnberg, Germany.
AJNR Am J Neuroradiol. 1993 Sep-Oct;14(5):1183-90.
To document the accuracy of CT and MR of the sella turcica for detecting adrenocorticotropic hormone-secreting adenomas in Cushing disease.
The radiologic findings of the sella turcica prior to transsphenoidal surgery are reviewed in 141 patients who had biochemical evidence of pituitary-dependent Cushing disease. Axial thin-collimation CT scans with sagittal and coronal reformations before and after contrast enhancement were obtained in 125 patients. Seventy-eight patients had MR examinations with a 1.5-T superconducting magnet. In 11 of the patients gadolinium-enhanced MR scans were also obtained. The preoperative interpretation of the imaging studies was correlated with the surgical findings and patients follow-up.
The sella turcica was enlarged in 43 cases (30%). In 125 patients reformatted or direct coronal thin-collimation CT scans were available. Seventy-eight of the patients had MR. In the 12 patients with pituitary macroadenomas, the accuracy of CT (n = 10) and MR (n = 10) in respect to detection of the lesion was 100%. Of the 98 microadenomas assessed by CT, 47 (48%) were directly depicted as distinct hypodense lesions. In only 31 of 73 cases (42%), however, could CT predict the precise anatomic location and extent of the lesions. Only patients in whom the hypercortisolism was corrected by later surgery were considered for the correlation analysis. Of the 52 microadenomas assessed by MR, 28 (53%) were directly depicted as distinct lesions of reduced signal intensity on T1-weighted images, and in only 21 of 41 cases (52%) did MR show good correlation to the surgical findings. Some degree of partially empty sella was found in 22% of the patients.
Although both the sensitivity and the diagnostic accuracy of imaging methods of the sella turcica have been considerably improved in comparison with previous reports, they still provide only a minor contribution to the diagnosis and differential diagnosis of Cushing syndrome.
记录蝶鞍的CT和MR检查在库欣病促肾上腺皮质激素分泌性腺瘤检测中的准确性。
回顾141例有垂体依赖性库欣病生化证据患者经蝶窦手术前蝶鞍的影像学表现。125例患者接受了增强前后的轴位薄层准直CT扫描及矢状位和冠状位重建。78例患者接受了1.5T超导磁共振检查。其中11例患者还进行了钆增强磁共振扫描。影像学检查的术前诊断与手术结果及患者随访情况进行对比。
43例（30%）蝶鞍增大。125例患者进行了重建或直接冠状位薄层准直CT扫描，78例患者进行了磁共振检查。在12例垂体大腺瘤患者中，CT（n = 10）和MR（n = 10）对病变的检测准确性均为100%。在CT评估的98例微腺瘤中，47例（48%）直接显示为明显的低密度病变。然而，在73例中的31例（42%）中，CT仅能预测病变的精确解剖位置和范围。仅对后期手术纠正了高皮质醇血症的患者进行相关性分析。在MR评估的52例微腺瘤中，28例（53%）在T1加权图像上直接显示为信号强度降低的明显病变，在41例中的21例（52%）中，MR与手术结果显示出良好的相关性。22%的患者存在某种程度的部分空蝶鞍。
尽管与既往报道相比，蝶鞍影像学检查方法的敏感性和诊断准确性均有显著提高，但它们对库欣综合征的诊断和鉴别诊断仍贡献较小。
