| BackgroundThe sellar region, which locates in the bottom of cerebral hemisphere and the center of the skull base, is a place the intracranial tumor often occurs. Pituitary adenoma is the most common benign tumor, whose incident rate is about10percent accounting for intracranial tumor, just lower than gliocytoma and meningeoma. As develop of neuroimage, the discoveryrate of pituitary adenoma increase year by year. The world studied late about growth pattern of the pituitary adenoma. Alvaro Campero et al. indicated that the anatomic variability of the diaphragm opening may explain the pattern of growth of pituitary adenoma. Wang Jianxin et al. stated that the lateral bone window (LBW) etc. of sella turcica can affect to different degrees the growth pattern of pituitary adenoma. But it is still not been studied about the relationship of bony opening of sella turcica and growth pattern of pituitary adenoma yet.According to different biological behavior, pituitary adenomas is divided into non-invasive pituitary adenomas and invasive pituitary adenomas (IPA). The present researches about IPA were mainly on the improvement to the ways of clinical surgery and the clinical effects, as well as the molecular biology of the basic researches, especially the on genetics and invasion indicators.It is still not been reported on the relationship of bony sella turcica type and the growth pattern of pituitary adenoma. In the present research, samples of Computed Tomography (CT) and Magnetic Resonance (MR) of Chinese adult and patients with pituitary adenoma were collected, with the help of associated software, the value of bony opening of sella turcica was measured successfully. The former sella turcica type was improved, and morphological characteristics of bony opening of sella turcica were first described and classified, its relations with the growth pattern of pituitary adenoma was explored. ObjectiveIn the present study, the of bony opening of sella turcica was observed and measured. Relations were explored between the sella turcica, bony opening of sella turcica and the growth pattern of pituitary adenoma. In order to provides imaging bases for the "hobby" of suprasellar extension of pituitary adenoma Materials and Methods1. Specimen for measurement100cases of pituitary adenoma CT/MR imaging data were collected from department of neurosurgery, Nanfang Hospital. All of the patients suffered of any of the clinical symptoms below:headache; amenorrhea; oligomenorrhea; decreased libid; galactorrhea; hand, foot, face, or tongue growth or enlargement, swelling etc.100imageology data of sellar turica region were collected to analyzed the anatomy of bony opening of sella turcica, and explored the relationship between the sella turcica, bony opening of sella turcica and the growth pattern of pituitary adenoma. Another20cases of adult CT/MR imaging data were collected to be the control group.2. Machine for measurementAll of the cases saddle thin sagittal reconstruction of horizontal and coronal CT scan images were measured and observed by the used of MAX-II computer tomography equipment which made in General Electric company. All the data were collected by the use of PACS system on the midline sagittal imaging. Typical pictures were reserved for purpose of getting ready for the follow-up use.3. Contents of measurementContents of measurement in the present study are as follows:①Sella turcica were observed and the former sella turcica classification was improved;②The relationship between the sella turcica classification, bony opening of sella turcica and the growth pattern of pituitary adenoma were explored;③The value of bony opening of sella turcica were measured, including the slant angle of bony opening of sella turcica;④the measurement of tumor-sellar angle;⑤the area value which the pituitary adenoma growed above or below the bony opening of sella turcica was measured, and the ratio between them was calculated.4. Methods of measurementAll the data were collected by the use of PACS system on the midline sagittal imaging. The measurement of straight line and degree was more simple compare to area in PACS system. So we zoomed in the image to a proper size to measured the area by drawing the outline of pituitary adenomas.5. Statistical processAll data processing were carried out in SPSS13.0statistical software. Mean of measurement data was compared with One-Sample T Test. The criterion for statistical significance for all tests was P<0.05.Results1. Improved sella turcica classificationIn this study, we improved the former sella turcica classification:Ⅰ bag-type; Ⅱ pot-type; Ⅲ tube-type, moreover, every type can be divided into two subtype: real-type and sifter-type. In the healthy group, the real bag-type accounts for43%, while the sifter bag-type11%, real pot-type21%, sifter pot-type5%, real tube-type14%, sifter tube-type6%. In the pituitary adenoma group, the real bag-type accounts for41%, while the sifter bag-type9%, real pot-type24%, sifter pot-type7%, real tube-type13%, sifter tube-type6%.2. The slant angle of bony opening of sella turcica (∠DAB)Draw a line AB in the bony opening of sella turcica, A is the tuberculum sellae and B is the midpoint of dorsum sellae. Draw another line CD in the base of anterior cranial fossa. And∠DAB illustrates the slant angle of bony opening of sella turcica. In this study, we divided the (?)DAB in the healthy adult into three types:Ⅰ anteverted type,∠DAB>5°, accounts for33%; Ⅱhorizontal type,-5°≤∠DAB≤5°, accounts for31%; Ⅲ retroverted type,∠DAB<-5°, accounts for36%.3. Tumor-sellar angle (∠EHB)The tumor-sellar angle defined as an angle between the longest diameter of the pituitary adenoma and the bony opening of sella turcica, because pituitary adenomas are always elliptic in the midline sagittal CT/MR imaging. The longest diameter would be defined as the distance from the highest point to the lowest point of the pituitary adenoma while a pituitary adenoma is not elliptic. The mean data of tumor-sellar angle is89.92°±10.78°, there is no statistical difference between tumor-sellar angle and90°(One-Sample,90°s test variable, t=-0.075, P=0.940>0.05). It means that the pituitary adenoma grows perpendicularly to the bony opening of sella turcica.4. The area value which the pituitary adenoma growed above or below the bony opening of sella turcica, and the ratio (X) between them.SA is defined as the the area value which the pituitary adenoma growed above the bony opening of sella turcica, SB is defined as the the area value which the pituitary adenoma growed below the bony opening of sella turcica, X=SA/SB. The mean SA was5.86±10.79mm2in microadenoma (range0～27.47mm2),137.56±111.17mm2in macroadenoma (range0-464.62mm2),430.38±222.98mm2in giant adenoma (range148.08±1044.58mm2). The mean X was0.09±0.17in microadenoma (range0～0.44),1.09±1.05in macroadenoma (range0～4.2),1.70±1.34in giant adenoma (range0.31±6.78). Based on the results above, X can be graded as follows:Grade1is X<1; Grade2is1≤X≤2; Grade3is X>2.ConclusionsIn this study, detailed measurement and observation of the relationship between the sella turcica, bony opening of sella turcica and the growth pattern of pituitary adenoma were carried on the thin sagittal reconstruction of horizontal and coronal CT scan images of the normal adults and pituitary adenoma patients. Combined with literature review, the following conclusions can be drawn:1. The precedence ordering of hindrance effect of bony opening of sella turcica would be:sifter bag-type>real bag-type>sifter tube-type>real tube-type>sifter pot-type> real pot-type.2. Pituitary adenomas grow perpendicularly to the bony opening of sella turcica.3. X should be recommended to evaluate the extent of a pituitary adenoma to grow to suprasellar region, the smaller X is, the harder a pituitary adenoma to grow upward.4. The slant angle of bony opening of sella turcica (∠DAB) can be divided into three types:anteverted type, horizontal type and retroverted type, it controls the direction of a pituitary adenoma growing upward and the following clinical symptom. |
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