背景:垂体大小的快速变化发生在青春期。因此,在患有垂体疾病的青少年中测量和报告磁共振成像(MRI)可能会引起放射科医师的不安。我们的目的是比较脑垂体的大小,茎和其他先前描述的成像工具在孤立的低促性腺激素性腺功能减退症(HH)患者与正常垂体的青少年中。
方法:41名患者(22名女性,19男,平均年龄16.3±2.0岁)的HH患者在开始激素治疗之前接受了MRI检查。年龄,性别,并注意到基因突变。垂体高度,冠状平面上的宽度,矢状平面上的前后(AP)直径,茎厚,脑桥比(PR),两名放射科医生两次测量了斜坡管角度(CCA)和克劳斯指数(KI),间隔一个月,彼此不了解患者信息。将测量结果与对照组进行比较,包括83例患者的下丘脑-垂体-性腺轴正常和垂体正常。还评估了评估者之间和评估者之间的协议。
结果:两组身高无显著差异,宽度或AP直径(p=0.437,0.836,0.681)。两组在CCA和PR方面没有发现显着差异(分别为p=0.890,0.412)。男性患者的KI显著高于女性患者和对照组(p<0.001)。评估者对垂体高度和宽度的一致性中等,垂体AP直径和茎厚度较差,对PR和KI有好处,非常适合CCA。
结论:脑垂体的测量,在有或没有孤立的HH的青少年中,茎和后窝结构相似。因此,脑垂体,在MRI上评估正常的垂体腺时,不需要测量茎或其他后颅窝。
Rapid changes in the size of the pituitary gland occur during the pubertal period. Therefore, measuring and reporting magnetic resonance imaging (MRI) in adolescents with pituitary disorders can cause unease among radiologists. Our aim was to compare the size of the pituitary gland, stalk and other previously described imaging tools in patients with isolated hypogonadotropic hypogonadism (HH) versus adolescents with a normal pituitary gland.
Forty-one patients (22 female, 19 male, mean age 16.3 ±2.0 years) with HH who underwent MRI prior to starting hormone treatment were enrolled. Age, sex, and genetic mutations were noted. Pituitary height, width on the coronal plane, anteroposterior (AP) diameter on the sagittal plane, stalk thickness, pons ratio (PR), clivus canal angle (CCA) and Klaus index (KI) were measured by two radiologists twice with a one-month interval blinded to each other and patient information. Measurements were compared with the control group, including 83 subjects with normal hypothalamic-pituitary-gonadal axis and normal pituitary gland on MRI. Inter-rater and intra-rater agreements were also evaluated.
No significant differences were found between the two groups regarding height, width or AP diameter (p = 0.437, 0.836, 0.681 respectively). No significant differences were found between the two groups regarding CCA and PR (p = 0.890, 0.412 respectively). The KI of the male patients was significantly higher than that of the female patients and the control group (p < 0.001). The interrater agreement was moderate for pituitary height and width, poor for pituitary AP diameter and stalk thickness, good for PR and KI, and excellent for CCA.
The measurements of the pituitary gland, stalk and posterior fossa structures were similar in adolescents with or without isolated HH. Consequently, pituitary gland, stalk or other posterior fossa measurements are unnecessary when evaluating a normal appearing pituitary gland on MRI.