| Chapter 1 The Analysis on Features of Pituitary Adenoma Apoplexy MRI PhasesObjective To explore the features of pituitary adenom apoplexy MRI phases.Methods 115 pituitary adenoma patients were collected,who are treated in our hospital’s neurosurgery department from January 2018 to September 2019.Among them,100 cases were enrolled,whose MRI features met the criteria for the MRI features of pituitary adenom apoplexy in this study.Grouped by MR signals,the early apoplexy group:apoplexy occurred in about 2 weeks,the apoplexy area showed low signal area on T2WI,without significant enhancement,whose surrounding area was not accompanied by>2mm cystic degeneration.Late apoplexy group:apoplexy occurred in about 2 weeks later,there is a>2mm cystic degeneration with fluid level or low signal area on T2WI.Relative T1WI enhancement and relative T2WI measurement method:Avoid the apoplexy area,select the region of interest(ROI)on 3 consecutive layers,Avoid the stroke site,select the region of interest(ROI)for 3 consecutive levels,and discard it if it is a full tumor type cystic degeneration or a full solid part showing T2WI low signal,the signal value automatically generated by software,take the average of three values,the same method measures the the value of white matter on the ipsilateral frontal lobe.Relative T2WI=non-apoplexy T2WI/frontal white matter T2WI,relative T1WI enhancement=non-apoplexy T1WI enhancement/frontal white matter T1WI enhancement.Results Among the 100 cases whose MRI features met the criteria in this study,25 cases showed early apoplexy signs:In the apoplexy area,17 cases showed low signal on T2WI and low/iso signal on T1WI;8 cases showed low signal on T2WI and high/iso signal on T1WI;75 cases showed late apoplexy signs:In the apoplexy area,18 showed a>2mm cystic degeneration with fluid level,57 cases showed a>2mm cystic degeneration with low signal area on T2WI.According to the above measurement method,the relative T1WI enhancement and relative T2WI values of the 73 non-apoplexy areas were measured.The average values of the relative T1WI enhancement and relative T2WI values in the early stroke group were smaller than those in the late apoplexy group.The difference was statistically significant(P<0.05).Conclusions The apoplexy area showed low signal on T2WI,without significant enhancement,high/low mixed signal on T1WI,in the early apoplexy phases.The apoplexy area showed cystic degeneration with fluid level or low signal area on T2WI,in the late apoplexy phases.In the non-apoplexy area,the T2WI signal intensity and T1WI enhancement effect was low in the early apoplexy,and the signal intensity increased after the improvement of blood supply in the late apoplexy.Chapter2 PDK1、HIF-1α in Pituitary Adenoma and Its Relevance with Apoplexy MRI PhasesObjective To detect the expression of pyruvate dehydrogenase kinase 1(PDK1)and hypoxia inducible factor-1α(HIF-1α)in pituitary adenomas,and analyze PDK1 expression in pituitary adenoma and its relationship with HIF-1α and MRI Phases.Methods Patients’ medical records and imaging data were the same as the first part,who were included in the group study,and 100 cases of their pathological tissue wax blocks were collected.The apoplexy MRI grouping of the tumor is the same as the first part.Immunohistochemical methods were used to detect the expression of PDK1 and HIF-1α in pituitary adenomas,and it was analyzed that the relationship between PDK1 and HIF-1α,apoplexy phases,age,gender,growth direction,and invasiveness.Results Among 100 pituitary adenomas,HIF-1α expression was positive in 49 cells,mainly in the nucleus,and the overall positive expression rate was 49%(49/100).The expression rate of HIF-1α in the early apoplexy group(76.0%,19/25)was higher than which in the late apoplexy group(40.0%,30/75).Among 100 pituitary adenomas,PDK1 expression was positive in 47 cells,mainly in the cytoplasm,and the overall positive expression rate was 47%(47/100).The expression rate of PDK1 in the early apoplexy group(68.0%,17/25)than which in the late apoplexy group(40.0%,30/75),the differences were statistically significant(P<0.05).There was a positive correlation between PDK1 and HIF-1α expression in pituitary denomas(P<0.05).In pituitary adenoma,it was no correlation that the expression of PDK1 with age,sex,growth direction,and invasiveness.Conclusions In hypoxic conditions,pituitary adenoma not only cause apoplexy,but also secrete HIF-1α and PDK1.The expression of HIF-1α in pituitary adenoma was related to time during apoplexy.HIF-1α was highly expressed in the early apoplexy group,and HIF-1 expression was decreased in the late apoplexy.In early apoplexy,pituitary adenoma can increase the expression of PDK1 to inhibit the glucose oxidative phosphorylation metabolic pathway,thereby reducing the oxygen consumption of the cells and decreasing the expression of PDK1 in the later apoplexy.Chapter3 The Comparative study of Metabolomics and MRI Phases in Pituitary Adenoma ApoplexyObjective To analyze the differences in metabolites and metabolic pathways between the pituitary adenoma early apoplexy group and the late apoplexy group.Methods The enrolled cases and imaging data were the same as the first part.Among them,65 fresh specimens were collected during the operation of pituitary adenoma.They were divided into early apoplexy group and late apoplexy group according to MRI features.Gas hromatography-mass spectrometry(GC-MS)was used to detect metabolites in tumor tissues.SIMCA-P software was used for principal component analysis(PCA),partial least squares discriminant analysis(PLS-DA),and orthogonal partial least squares-discrimination analysis(OPLS-DA),and to screen the differential metabolic pathways and products between the two groups.Results Twenty-six differential metabolites were detection and analysis.There are 13 metabolites:dihydroxyacetone phosphate,ornithine,heptadecanoic acid,glutamic acid,11,14-icosenedioenoic acid,linoleic acid,aspartic acid,xylulose,y-Linolenic acid,gallic acid,oleic acid,11-icosenoic acid,3-amino-2-piperidone),which were significantly lower in the early apoplexy group than in the late apoplexy group.There are also 13 types:inositol 1-phosphate,glycine,arachidonic acid,asparagine,guanosine 5-phosphate,adenine,cysteine sulfonic acid,mannitol,inositol,succinic acid,and 5-phosphate muscle Glucoside,adenosine 5-phosphate,uridine 5’-monophosphate,which were significantly lower in thelate apoplexy group than in the early apoplexy group.Conclusions There are differences in polyunsaturated fatty acid metabolism,amino acid metabolism,and purine metabolism pathways in different pituitary adenoma apoplexy phases.In the early apoplexy phases,the increase of glutamic acid,linoleic acid,aspartic acid,and r-linolenic acid is related to more severe ischemia and hypoxia.Their contents decreases after the improvement of hypoxia in the late apoplexy.In the late apoplexy phases,the enhancement of acid,glycine,and adenosine 5-phosphate metabolism is related to the continued growth and proliferation of tumors.Ischemia and hypoxia lead to the corresponding MRI signs by changing the metabolic status of pituitary adenomas.It is helpful for accurate treatment and diagnosis that understanding the correlation between tumor MRI signs and metabolism. |
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