目的 探讨动态增强磁共振(DCE-MRI)血管功能参数在垂体微腺瘤诊断中的价值.方法 回顾性分析经临床表现、实验室检查、MRI检查及诊断性治疗证实的34例泌乳素微腺瘤患者、24例单纯泌乳素升高患者及20例健康人的DCE-MRI图像,获得垂体及微腺瘤微血管渗透性定量参数及半定量参数(容量转移常数Ktrans、Ve、速率常数Kep、达峰时间TTP).采用t检验分析微腺瘤与邻近正常腺垂体组织各参数值的差异;采用方差分析对比微腺瘤组、单纯泌乳素升高组、健康对照组之间及健康对照组腺垂体左侧、中间、右侧之间各参数之间的差异;两两比较采用最小显著差异法;通过ROC曲线对各参数诊断微腺瘤的敏感度及特异度进行分析.P<0.05为差异具有统计学意义.结果 1)垂体中间部位TTP值小于左侧及右侧,差异具有统计学意义;2)微腺瘤较邻近正常腺垂体组织的Ktrans、Kep值降低,TTP值升高,差异具有统计学意义;3)微腺瘤组较单纯泌乳素升高组及健康对照组的Ktrans、Kep值降低,TTP值升高,差异具有统计学意义.而单纯泌乳素升高组较健康对照组的Ktrans、Kep、TTP值差异无统计学意义;4)对微腺瘤的诊断,参数Ktrans、Kep诊断效能均高于TTP.Ktrans-Kep联合诊断的诊断效能高于Ktrans-TTP及TTP-Kep联合.Ktrans-Kep-TTP三者联合诊断效能最高.结论DCE-MRI功能参数可反映垂体微腺瘤的微血管变化,定量参数Kep对微腺瘤的诊断效能较高,多参数联合有助于进一步提高垂体微腺瘤的诊断水平.%Objective To investigate quantitatively microvascular parameters in pituitary microadenomas by dynamic contrast -enhanced magnetic resonance imaging ( DCE-MRI) .Methods MRI date was analyzed in 20 normal female adenohypophysis , 24 patients with hyperprolactinemia and 34 patients with pituitary hyperprolactinemia microadenomas conformed with clinical , labora-tory examination or diagnostic treatment retrospectively .The microvascular function parameters of pituitary gland ( volume transfer constant, Ktrans;extravavascular extracelluar volume fraction , Ve;rate constant, Kep;time to peak, TTP) were obtained.A t test was used to compare the difference of parameters between microadenomas and its surrounding pituitary tissue .Analysis of variance ( ANOVA ) was used to evaluate the difference of parameters among these three groups and the difference of parameters of left, median and right pituitary gland in control group .Least significant difference ( LSD) was used for pairwise comparison .The sensi-tivity and specificity of each parameter in diagnosing pituitary microadenomas were analyzed by ROC curve .A P value of ≤0.05 was considered significant .Results 1) TTP value was significantly lower in media pituitary gland than that in left and right pitui -tary gland;2) Ktrans and Kep value of pituitary microadenomas were significantly lower and TTP value of pituitary microadenomas was significantly higher than those of their surrounding tissue respectively;3) Ktrans and Kep value were significantly lower and TTP value was significantly higher in microadenomas group than those in both hyperprolactinemia and control group .There was no sig-nificant difference in Ktrans, Kep and TTP between hyperprolactinemia and control group;4) The diagnostic efficacy of Ktrans and Kep was significantly higher than that of TTP for micro-adenomas.The diagnostic efficacy of the combined use of K trans-Kep was sig-nificantly higher than that of the combined use of K trans-TTP, and TTP and Kep, respectively.The diagnostic efficacy of the com-bined use of K trans-Kep-TTP was the highest for microadenomas .Conclusion The vascular functionnal parameters in DCE-MRI could quantitatively analyze the microvascular change of pituitary microadenomas , parameter Kep show higher diagnostic efficacy and the combined use of multi-parameters is helped to improve the diagnosis of pituitary microadenomas .
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