摘要:
Objective ToexploretheMRIfeaturesofgrowthhormonedeficiency(GHD)inchildrenwithshortstaturecausedby pituitarylesions,inordertoimprovethediagnosticlevelofthesediseases.Methods MRIandclinicaldataof624patientsofGHD withshortstaturecausedbypituitarylesionswereretrospectivelyanalyzed.Results Inshortstaturecausedbypituitarylesions,there were383caseswithanteriorpituitarydysplasia(61.4%);49casesofpituitarystalkinterruptionsyndrome(PSIS)(7.9%);16cases ofpituitaryhyperplasiaduetoprimaryhypothyroidism (2.6%);41casesofRathkecleftcyst(6.6%);74casesofemptysellasyndrome(11.9%);17 casesofpituitaryinvasionbyLangerhanscellhistiocytosis(2.7%);2casesofsellarregionalarachnoidcyst(0.3%);and42casesof craniopharyngioma(6.7%).MRIshowedtheheightofanteriorpituitarywaslessthannormal,andthelocation,sizeandsignalsof posteriorpituitaryandpituitarystalkwerenormalinanteriorpituitarydysplasia.Noorthinpituitarystalk,anteriorpituitaryhypoplasiawith ectopicposteriorpituitarywereseeninPSIS.Allofthepituitaryhyperplasiawerecausedbyhypothyroidism,inwhich MRIshowed anteriorpituitaryenlargement,upwardapophysis,obvioushomogeneousenhancement,nopituitarystalkinterruptionandabnormal signal,andthepituitaryglandreducinginsizeafterreplacementtherapy.Stalkhypophysialwasthickeningtogetherwithadisappearanceof hyperintenseoftheposteriorlobeofpituitaryglandonT1,andthesizeandsignalsofanteriorpituitarywerenormalinpituitarybeing invadedbyLangerhanscellhistiocytosis.AtrophyofanteriorpituitarywasseeninRathkecleftcyst,emptysellasyndrome,sellarregionalarachnoid cystandcraniopharyngioma.Conclusion MRIcanclearlyshowtheanatomyofpituitaryandsellarregion,whichcanprovideamorphological referencefortheearlydiagnosisanddifferentialdiagnosisofGHDinchildrenwithshortstaturecausedbypituitarylesions,andisof clinicallyimportantfortreatmentandprognosis.%目的 探讨生长激素缺乏(GHD)矮小儿童垂体疾病的 MRI表现,提高对该类疾病的诊断水平.方法 回顾性分析624例经临床确诊为GHD矮小儿童垂体病变的 MRI表现及临床资料.结果 GHD矮小儿童垂体疾病包括腺垂体发育不良383例(61.4%),垂体柄阻断综合征(PSIS)49例(7.9%),原发性甲状腺功能减退性垂体增生16例(2.6%),Rathke囊肿41例(6.6%),空泡蝶鞍综合征74例(11.9%),朗格汉斯细胞组织细胞增生症(LCH)垂体侵犯17例(2.7%),鞍区蛛网膜囊肿2例(0.3%),颅咽管瘤42例(6.7%).腺垂体发育不良表现为垂体前叶高度小于正常值,垂体后叶位置及信号正常,垂体柄未见中断、变细及异常信号.PSIS表现为垂体前叶发育不良,垂体柄缺如或变细,垂体后叶异位.垂体增生由甲状腺功能减退所致,表现为垂体前叶体积增大,上缘隆起,增强扫描呈明显均匀强化,垂体柄未见中断及异常信号,激素替代治疗后垂体缩小.LCH垂体侵犯表现为垂体柄增粗,垂体后叶在T1上失去高信号,垂体前叶大小及信号可正常.Rathke囊肿、空泡蝶鞍综合征、鞍区蛛网膜囊肿及颅咽管瘤均表现为垂体前叶萎缩变薄.结论 MRI能清晰地显示垂体及鞍区的微细结构,是检出垂体病变的重要手段,能够准确地显示GHD矮小儿童各种垂体疾病的特点,具有很高的临床实用性,有助于临床疾病的早期诊断和鉴别诊断,并可监测其治疗效果.