目的:据报道,由于肿瘤的压迫作用,视觉障碍是垂体腺瘤(PA)最常见的临床表现。这项前瞻性研究旨在评估扩散张量成像(DTI)在PA患者视力改善中的预测作用。他们是鼻内镜手术的候选人。
方法:共13例患者(男性,8;女性,5)因垂体大腺瘤引起的视力障碍被纳入本研究。DTI的发现和视觉参数,包括视敏度(VA),视野(VF),和视觉诱发电位(VEP),在手术前和手术后三个月对所有参与者进行记录。
结果:据报道,PA手术后VA和VF均有显著恢复(P<0.001)。视野检查结果表明所有象限都恢复了,除了右眼的下鼻象限.肿瘤体积与术前视神经无明显相关性,视神经束,和chiasm分数各向异性(FA)或平均扩散率(MD)。术前视神经MD较低的患者更有可能恢复VA和VF。此外,术前视神经FA升高与VA恢复的概率较高相关.视束MD和FA值与视力改善之间没有显着相关性。总的来说,MD值低于0.0021,FA值高于0.1689可以预测术后VA恢复的良好预后。
结论:DTI可能在评估PA患者术前视力改善方面具有预测价值。
Visual impairment has been reported as the most common clinical manifestation of pituitary adenoma (PA) due to the compressive effect of the tumor. This prospective
study aimed to evaluate the predictive role of diffusion tensor imaging (DTI) in the visual improvement of patients with PA, who were candidates for endoscopic endonasal surgery.
A total of 13 patients (male, 8; female, 5) with visual impairment due to pituitary macroadenoma were enrolled in this
study. The DTI findings and visual parameters, including visual acuity (VA), visual field (VF), and visual evoked potential (VEP), were recorded for all participants before and 3 months after surgery.
Significant recovery was reported in both VA and VF following PA surgery (P < 0.001). The results of perimetry indicated recovery in all quadrants, except for the lower nasal quadrant of the right eye. The tumor volume showed no significant association with the preoperative optic nerve, optic tract, and chiasm fractional anisotropy (FA) or mean diffusivity (MD). The VA and VF recoveries were more likely in patients with a lower preoperative optic nerve MD. Besides, increased preoperative FA of the optic nerve was associated with a higher probability of VA recovery. No significant correlation was found between the optic tract MD and FA values and visual improvement. Overall, MD values below 0.0021 and FA values above 0.1689 could predict a good prognosis of VA recovery after surgery.
DTI may have a predictive value in estimating visual improvement in patients with PA preoperatively.