A Imaging Study Of Pituitary Adenoma Invading The Cavernous Sinus

Part Ⅰ:The Value of MRI 3D SPACE T2 WI in the Diagnosis of Pituitary Adenoma Invading Cavernous SinusObjective The imaging characteristics of the medial wall of the cavernous sinus in different sequences of MRI were analyzed retrospectively,and the diagnostic value of the integrity of the medial wall of the cavernous sinus in SPACE sequence for pituitary adenomas invading the cavernous sinus was evaluated.Methods From November 2018 to December 2019,we collected cases of pituitary MRI examination in our medical imaging center.Inclusion criteria:①complete medical records;②pituitary MRI examination with 3.0T MRI scanner in our hospital;exclusion of cases with previous history of sellar surgery,radiotherapy and drug treatment.The shape and continuity of the medial wall of the cavernous sinus were observed in the coronal position of MRI 3D SPACE T2 WI.The invasiveness of pituitary adenoma was evaluated by modified Knosp-Steiner classification,percentage of pituitary tumor around the internal carotid artery of cavernous sinus,and quadrant of tumor invading cavernous sinus.Results The imaging quality of 3D SPACE T2 WI was better than that of CE T1 WI TSE and T2 WI TSE（P < 0.05）.Compared with Knosp classification,ICA coverage,and cavernous sinus quadrant invasion,3D SPACE T2 WI has more advantages in the diagnosis of pituitary adenoma invasion.Conclusions①The imaging quality of 3D SPACE T2 WI is better than that of CE T1 WI TSE and T2 WI TSE.②The value of 3D SPACE T2 WI in the diagnosis of pituitary adenoma invading cavernous sinus is higher than that of traditional MRI.Part Ⅱ:The Value of MRI 3D SPACET2 in the Diagnosis of Pituitary Adenoma Invading Cavernous SinusObjective Through the retrospective analysis of the relevant imaging data of pituitary macroadenoma cases,to explore the relevant factors affecting the parasellar expansion of pituitary adenomas.Methods From November 2018 to December 2019,the imaging data of MRI and CT examination of patients undergoing transsphenoidal tumor resection were collected.Cases with previous history of sellar surgery,radiotherapy and drug treatment were excluded,and cases with incomplete imaging data were excluded.All the cases were scanned with 3.0 TMR scanner in our hospital.The scanning sequence includes: sagittal and axial T1 WI,coronal 3D SPACE T2 WI,sagittal T1 WI and coronal enhancement.All patients underwent CT scan of paranasal sinuses or head before operation.The imaging data is complete.The diagnosis of pituitary macroadenoma was confirmed by preoperative examination and postoperative pathology.The parameters of pituitary MR were:①the height of suprasellar extension;②the height of pituitary tumor;③the maximum transverse diameter of pituitary tumor;④the length of cavernous segment of internal carotid artery;⑤the interval between cavernous segments of internal carotid artery.Preoperative CT findings:①type of sphenoid sinus gasification:②angle of sella turcica;③anteroposterior diameter of sella superior opening;④maximum anteroposterior diameter of hypophysis fossa;⑤shape of sella turcica;⑥area of lateral opening of sella turcica.The observation indexes of the degree of parasellar expansion of pituitary adenomas were as follows:①modified knosp Steiner classification method;②the percentage of pituitary adenomas around the internal carotid artery of cavernous sinus;③the integrity of the medial wall of cavernous sinus in MRI 3D SPACE T2 WI.Results The largest transverse diameter of pituitary adenoma,the area of the lateral opening of sella turcica,and the distance between ICA cavernous segments were independent factors of Knosp classification.Among them,the largest transverse diameter of pituitary adenoma and the area of the lateral opening of sella turcica were negatively correlated with the size of Knosp,and the distance between ICA cavernous segments was positively correlated with the size of Knosp.The regression coefficient was-0.031,which indicated that the greater the area of the external opening of sella turcica,the greater the degree of the internal carotid artery.There was no statistical difference in the effect of all indexes on the integrity of the medial wall of the cavernous sinus.Conclusions①The larger the transverse diameter of pituitary adenoma and the area of the lateral opening of sella turcica,the easier the pituitary adenoma grows to the parasella.The larger the distance between the cavernous segments of internal carotid artery,the less the pituitary adenoma grows to the parasella.②The larger the area of the lateral opening of sella turcica,the more easily the pituitary adenoma surrounds the cavernous segments of internal carotid artery.Part Ⅲ: MRI research of blood supply characteristics of pituitary adenomas invading cavernous sinusObjective To investigate the difference of dynamic enhanced quantitative parameters and time signal intensity curve between tumor tissue in sella and cavernous sinus of pituitary macroadenoma,and to evaluate the blood supply characteristics of tumor tissue in sella and cavernous sinus of pituitary macroadenoma.Methods From November 2018 to December 2019,the imaging data of MRI and CT examination of patients undergoing transsphenoidal tumor resection were collected.All the cases were scanned with 3.0 TMR scanner in our hospital.All dynamic enhanced images of pituitary MRI will be post processed by image processing workstation.The appropriate ROI was selected from sella turcica and cavernous sinus of pituitary macroadenoma,and the time enhancement curve was obtained.Quantitative parameters such as K^trans,K_ep,V_e,iAuc,rT2WI were measured.Results K^trans and K_ep of tumor tissue in sella turcica were significantly higher than those in cavernous sinus（P < 0.05）,and rT2WI of tumor tissue in sella turcica was significantly higher than that in cavernous sinus（P < 0.05）.Conclusions①The blood supply of pituitary macroadenoma invading cavernous sinus was poor;②The blood perfusion and microvascular formation of tumor tissue in sella turcica were more abundant than that in cavernous sinus.