Visual pathway impairment by pituitary adenomas: quantitative diagnostics by diffusion tensor imaging.
Visual pathway impairment by pituitary adenomas: quantitative diagnostics by diffusion tensor imaging.
复制标题
垂体腺瘤引起的视觉通路损伤：弥散张量成像定量诊断。
作者：
Y. Lilja;Oscar Gustafsson;M. Ljungberg;G. Starck;B. Lindblom;T. Skoglund;Henrik Bergquist;K. Jakobsson;D. Nilsson
目的尽管在手术治疗垂体腺瘤方面有丰富的经验，但对于可能揭示肿瘤生长导致前视路受压而导致视力损害的客观指标却知之甚少。本研究旨在探讨弥散张量成像(DTI)作为一种客观评估垂体腺瘤对前视路损伤的方法。方法23例经蝶入路手术的垂体腺瘤患者和20例健康体检者。根据SIPAP(鞍上、鞍下、鞍旁、鞍前和鞍后)分级，鞍上肿瘤最小范围为2-4级。所有受试者均完成神经眼科检查、常规MRI和DTI检查，并在术后6个月复查。定量评估视交叉抬高、视野缺陷(VFD)和视束DTI参数。在对照组和患者中进行线性相关、组比较和预测模型。结果VFD和交叉抬高程度与径向弥散系数(r=0.55，p<；0.05)和各向异性分数(r=-0.58，p<；0.05和r=-0.47，p<；0.05)显著相关(r=0.55，p<；0.05和r=0.48，p<；0.05)。无论是手术前还是手术后，VFD患者和对照组之间的轴向弥散率均有显著差异(p<；0.05)；然而，VFD患者和无VFD患者之间的轴向弥散率没有发现差异。根据轴向弥散率和各向异性分数，预测模型将所有VFD患者正确分类(敏感性1.0)，12例非VFD患者中9例正确(敏感性0.75)，20例对照组中17例为对照组(特异性0.85)。结论DTI可以检测出垂体腺瘤压迫视神经前通路的病理改变和损伤程度。放射状弥散系数和视力损害之间的相关性可能反映了肿瘤效应增加导致的视觉通路的逐渐脱髓鞘。在患者组中发现的低水平的轴向弥散系数可能代表着视觉通路的早期萎缩，这在DTI上是可以检测到的，但通过常规方法是不能检测到的。DTI可提供客观数据，发现早期损伤征象，并可作为确定垂体腺瘤手术指征的辅助诊断工具。
OBJECTIVE Despite ample experience in surgical treatment of pituitary adenomas, little is known about objective indices that may reveal risk of visual impairment caused by tumor growth that leads to compression of the anterior visual pathways. This study aimed to explore diffusion tensor imaging (DTI) as a means for objective assessment of injury to the anterior visual pathways caused by pituitary adenomas. METHODS Twenty-three patients with pituitary adenomas, scheduled for transsphenoidal tumor resection, and 20 healthy control subjects were included in the study. A minimum suprasellar tumor extension of Grade 2-4, according to the SIPAP (suprasellar, infrasellar, parasellar, anterior, and posterior) scale, was required for inclusion. Neuroophthalmological examinations, conventional MRI, and DTI were completed in all subjects and were repeated 6 months after surgery. Quantitative assessment of chiasmal lift, visual field defect (VFD), and DTI parameters from the optic tracts was performed. Linear correlations, group comparisons, and prediction models were done in controls and patients. RESULTS Both the degree of VFD and chiasmal lift were significantly correlated with the radial diffusivity (r = 0.55, p < 0.05 and r = 0.48, p < 0.05, respectively) and the fractional anisotropy (r = -0.58, p < 0.05 and r = -0.47, p < 0.05, respectively) but not with the axial diffusivity. The axial diffusivity differed significantly between controls and patients with VFD, both before and after surgery (p < 0.05); however, no difference was found between patients with and without VFD. Based on the axial diffusivity and fractional anisotropy, a prediction model classified all patients with VFD correctly (sensitivity 1.0), 9 of 12 patients without VFD correctly (sensitivity 0.75), and 17 of 20 controls as controls (specificity 0.85). CONCLUSIONS DTI could detect pathology and degree of injury in the anterior visual pathways that were compressed by pituitary adenomas. The correlation between radial diffusivity and visual impairment may reflect a gradual demyelination in the visual pathways caused by an increased tumor effect. The low level of axial diffusivity found in the patient group may represent early atrophy in the visual pathways, detectable on DTI but not by conventional methods. DTI may provide objective data, detect early signs of injury, and be an additional diagnostic tool for determining indication for surgery in cases of pituitary adenomas.
影响因子：
4.2
作者：
Kerrison, JB;Lynn, MJ;Newman, NJ
通讯作者：
Newman, NJ