摘要目的 利用海绵窦内侧壁的MRI特征,评价垂体腺瘤侵袭海绵窦的术前评估价值.方法 运用Siemens 3.0 T磁共振机扫描39例垂体腺瘤,观察海绵窦内侧壁完整性、Knosp - Steiner分级、颈内动脉被包绕程度、海绵窦间隙受侵犯程度等,手术探查双侧海绵窦内侧壁,活检鞍底硬脑膜,计算肿瘤Ki - 67标记指数,并行相关统计分析.结果 利用MRI海绵窦内侧壁完整性判断垂体腺瘤侵袭海绵窦具有良好的诊断价值(PPV 75％,NPV 100％,约登指数0.952,ROC曲线下面积0.976),与Knosp - Steiner分级、颈内动脉被包绕程度、海绵窦间隙受侵犯程度等指标具有一致性(Kappa值0.788、0.611、0.732).MRI海绵窦内侧壁完整性与鞍底硬脑膜受肿瘤侵犯及Ki - 67 LI之间均相关.结论 利用3.0 T MRI显示海绵窦内侧壁,在术前诊断垂体腺瘤侵袭海绵窦具有重要价值,对手术方案的选择、术中操作有指导意义.

abstractsObjective To evaluate the value of MRI characteristics of medial wall of cavernous sinus in preoperative assessment of invasive pituitary adenomas,Methods The MRI scans of 39 pituitary adenomas were obtained with a 3.0 T MRI scanner preoperatively.Special attention was given to the integrity of the medial wall of cavernous sinus,Knosp- Steiner grading scales,relationship between tumor and internal carotid artery and possible infiltration of cavernous sinus.Then all the patients received operations,37 cases through transspheniodal approach and 2 transcranial approach.The dura of sellar floor and tumor tissue were obtained intraoperatively to assess the growth pattern of tumor by histologically verified dural invasion and Ki -67 labeling index( Ki -67 LI),respectively.The surgical and pathological findings were compared with the MRI findings.Results The integrity of the medial wall of cavernous sinus were compared with the surgical findings,the positive predictive value (PPV),negative predictive value (NPV),Youden index and the area under ROC curve to infiltration of the medial wall were 75％,100％,0.952,0.976,respectively,demonstrating good diagnostic value on cavernous sinus invasion (CSI).The kappa value was 0.788,0.732,0.611between the integrity of the medial wall of cavernous sinus and Knosp - Steiner grading scale,relationship between tumor and internal carotid artery and possible infiltration of cavernous sinus,respectively,which revealed consistency among them.Accordingly,the integrity of the medial wall of cavernous sinus was related to the dural invasion of sellar floor and the Ki -67 LI.Conclusions The integrity of the medial wall of cavernous sinus on 3.0 T MRI is an important preoperative predictor of CSI,which will guide the resection schedule and a safer and less invasive access to the lesion located in cavernous sinus.