垂体少见疾病的MRI诊断及鉴别诊断_李涛

作者单位:100853北京,解放军总医院放射科(李　涛、马　林、梁　丽、梁　燕、郭行高、邬海博);100039北京,武警总医院核医学科(周卫华);＊在读博士生,现工作单位:武警总医院CT 室

中枢神经放射学

垂体少见疾病的MRI 诊断及鉴别诊断

李　涛＊,马　林,周卫华,梁　丽,梁　燕,郭行高,邬海博

【摘要】　目的　探讨垂体少见疾病的M RI 特点,提高对垂体少见疾病的认识。资料与方法　回顾性分析10例经临床或病理证实的垂体少见疾病的M RI 表现,包括Rathke 's 囊肿3例,垂体增生3例,淋巴细胞性垂体炎3例,颗粒细胞瘤1例。结果　Rathke 's 囊肿表现为垂体内边界光滑、信号均匀的囊性病变。垂体增生表现为垂体增大,垂体柄增粗,明显均匀一致的强化。淋巴细胞性垂体炎3例,表现为垂体增大,垂体柄增粗,与垂体信号相仿,2例信号均匀,1例信号不均匀,增强扫描病变明显强化;1例有邻近的硬膜强化。颗粒细胞瘤表现为垂体柄均匀增粗,明显均匀一致的强化。结论　M RI 能清楚地显示病变的范围和特点,具有重要的诊断和鉴别诊断价值。【关键词】　Rathke 's 囊肿　垂体增生　淋巴细胞性垂体炎　颗粒细胞瘤

MR I Diagnosis and Differential Diagnosis of Uncommon Diseases of Pituitary Gland

LI Tao ,MA Lin ,ZHOU Weihua ,et al .

Department of Radiology ,PLA General Hospital ,B eijing 100853,P .R .China

【Abstract 】　Objective To investigate MRI characteristics of uncommon diseases of pituitary gland and improve the knowledge for these d iseases .Materials and Methods MRI stud ies of 10patients with pathologically or clinically confirmed uncommon d is -eases of pituitary gland were reviewed retrospectively ,including Rathke 's cysts in 3cases ,pituitary hyperplasia in 3cases ,lym -phocytic hypophysitis in 3cases and granular cell tumor in 1case .Results 3cases with Rathke 's cysts showed cystic appear -ances with homogenous intens ity and clear margin in the pituitary gland .3cases with pituitary hyperplasia showed enlarged pitu -itary glands and stalks with homogenous enhancement .3cases with l ymphocytic h ypophysitis showed enlarged pituitary glands and stalks with markedly enhancement .The signal was heterogenous in 1case and dura was enhanced in 1case .1case with granular cell tu mor showed enlarged stalk with homogenous enhancement .Conclusion MRI can clearly detect the extent and feature of the uncommon diseases of pituitary gland ,and it has significant clinical value in the diagnosis and differential diagnosis .【Key words 】　Rathke 's cyst Pituitary hyperplasia Lymphocytic hypophysitis Granular cell tu mor

垂体是重要的内分泌器官,最常见的垂体病变是垂体瘤。但是垂体的病变多种多样,对一些垂体少见病变如垂体增生、淋巴细胞性垂体炎、垂体颗粒细胞瘤等人们常常缺乏认识,从而引起误诊。笔者搜集近年来我院经病理和临床证实的垂体少见疾病10例,探讨MRI 的诊断价值,以提高对垂体病变的认识。1　资料与方法

1.1　临床资料

本组10例中,Rathke 's 囊肿3例,男2例,女1

例,年龄分别为44、32和38岁;1例表现为复视、头痛,其余2例偶然发现。实验室检查未见异常。垂体增生3例,男1例,女2例,年龄分别为10、15和18岁,临床表现为身材矮小,反应迟钝,畏寒、性情多变、皮肤粗糙。实验室检查:血液中游离T 3、T 4明显低于正常值,垂体分泌的促甲状腺激素明显增高。淋巴细胞性垂体炎3例,均为女性,年龄分别为20、22和25岁,临床表现为眼睑肿胀,多饮、多尿,头痛,复视,溢乳,体重下降。实验室检查:性腺激素偏低1例,泌乳素增高1例,中枢性尿崩3例。颗粒细胞瘤1例,男,14岁。临床表现为多饮、多尿2个月,禁水加压试验提示中枢性尿崩。以上病例除3例垂体增生是根据临床表现和实验室检查诊断外,其余均经病理证实。1.2　MR 检查方法

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216·临床放射学杂志2007年第26卷第3期

DOI :10.13437/j .cn ki .jcr .2007.03.003