鞍旁颈内动脉狭窄在侵袭性垂体瘤与侵袭性脑膜瘤中的鉴别价值

摘要

目的评估鞍旁颈内动脉狭窄在侵袭性垂体瘤与侵袭性脑膜瘤中的鉴别价值.方法 回顾性分析2012年1月至2016年12月在重庆医科大学附属第一医院神经外科确诊的28例侵袭性垂体瘤及15例侵袭性脑膜瘤患者的影像学资料,总结常见的影像学特征;测量计算机体层摄影血管成像(CTA)图像上被包绕颈内动脉最狭窄处的直径(Dstenosis)、面积(Astenosis),计算狭窄分数(％stenosis);采用受试者工作特征曲线(ROC)分析各项测量指标的诊断效度.结果侵袭性垂体瘤患者的中位Ki-67为3％(2％～5％),明显高于侵袭性脑膜瘤的1％(1％～2％)(Z=-3.983,P=0.000);两组患者的肿瘤质地差异有统计学意义(P =0.001).MRI结果显示,侵袭性垂体瘤直径平均为(39.63 ±13.15) mm,侵袭性脑膜瘤为(37.09±16.13) mm,差异无统计学意义(t=0.518,P=0.607);两组患者在肿瘤形状(P=0.010)、T1WI (P =0.000)、信号均匀性(P =0.000)、强化程度(P=0.000)、与正常垂体分界(P =0.001)、脑膜尾征(P=0.000)及颅骨改变(P =0.001)等方面差异均有统计学意义.ROC曲线分析结果显示,Dstenosis的AUC为0.725,P=0.006,界值为3.45 mm,灵敏度为62.50％,特异度为76.47％;Astenosis的AUC为0.737,P=0.003,界值为11.00 mm2,灵敏度为75.00％,特异度为64.71％;％stenosis的AUC为0.711,P=0.013,界值为0.306,灵敏度为43.75％,特异度为97.06％.结论除常见的影像学特征外,鞍旁颈内动脉狭窄可作为侵袭性垂体瘤及侵袭性脑膜瘤的重要鉴别手段,被包绕颈内动脉的Dstenosis、Astenosis及％sstenosis3项指标具有一定的诊断效度.%Objective To assess the value of internal carotid artery stenosis in differentiating invasive pituitary adenoma (IPA) from invasive meningiomas (IM).Methods The clinical and imaging data of 28 IPA patients and 15 IM patients who were treated in our center from January 2012 to December 2016 were retrospectively analyzed.The magnetic resonance imaging (MRI) features were analyzed.The narrowest diameter (Dstenosis) and area (Astenosis) of internal carotid artery around the tumor were measured by computed tomography angiography (CTA),followed by the calculation of the stenosis score (％ stenosis).The diagnostic validity of the measured indicators were calculated by receiver operating characteristic (ROC) curve.Results The median Ki-67 was 3％ (2％-5％) in IPA group,which was significantly higher than that in IM group (1％,1％-2％)(Z =-3.983,P =0.000).The tumor texture showed significant differences between these two groups (P =0.001).While there was no significant difference in the average diameter [(39.63 ± 13.15) mm in IPA group vs.(37.09±16.13) mm in IM group (t =0.518,P=0.607)],the shape (P=0.010),T1WI (P=0.001),signal (P =0.000),post-gadolinium enhancement (P =0.000),separation from normal pituitary (P =0.001),dural tail sign (P =0.000),and skull (P =0.001) showed significant differences.ROC analysis showed that the AUC of Dstenosis was 0.725 (P =0.006),the cut-off was 3.45 mm,the sensitivity was 62.50％,and the specificity was 76.47％;the AUC of Astenosis was 0.737 (P =0.003),the cut-off level was 11.00 mm2,the sensitivity was 75.00％,and the specificity was 64.71％;finally,the AUC of ％ stenosis was 0.711 (P =0.013),the cut-off level was 0.306,the sensitivity was 43.75％,and the specificity was 97.06％.Conclusions In addition to the common imaging features,the internal carotid artery stenosis is a valuable tool for differentiating IPA from IM.Three indicators including Dstenosis,Astenosis,and ％ stenosis have moderate diagnostic validity.