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目的分析比较大和巨大垂体腺瘤经蝶手术后不同时期核磁共振检查的影像学特点,探讨MRI对手术疗效评估的最佳时机。方法追踪、随访直径≥2cm垂体腺瘤72例,其中PRL瘤37例,无功能性腺瘤25例,GH腺瘤2例,ACTH腺瘤2例,多分泌激素腺瘤6例。分别于术后早期(术后1～2周)、三个月、半年核磁共振检查,其中45例MRI随访一年以上,进行动态观察比较。结果72例术后早期MRI复查确定瘤影完全消失34例(47．2%)；11例术后早期MRI检查报告残留,半年后复查3例消失,8例残留；27例(37．5%)术后早期MRI不能明确判定疗效,半年后复查完全切除22例,5例残留。45例术后随访一年,其MRI表现与术后半年的表现相似。结论术后半年的MRI能较好的判断手术效果,有利于术后辅助治疗方案的选择。
OBJECTIVE: To analyze the imaging characteristics of MRI at different periods after transsphenoidal surgery of large and giant pituitary adenomas, and to explore the best timing for evaluating the curative effect of MRI. Methods Totally 72 cases of pituitary adenomas of diameter ≥2 cm were followed up. There were 37 cases of PRL tumors, 25 cases of non - functioning adenoma, 2 cases of GH adenoma, 2 cases of ACTH adenoma and 6 cases of secreting hormone adenoma. Respectively in the early postoperative (1 to 2 weeks after surgery), three months, six months MRI, of which 45 cases of MRI follow-up more than one year, the dynamic observation and comparison. Results 72 cases (47.2%) had complete disappearance of neoplasm in the early postoperative MRI examination; 11 cases had residual MRI in the early postoperative period; 3 cases disappeared after 6 months and 8 cases remained; 27 cases (37.5% ) Early postoperative MRI can not be clearly determined efficacy, six months after the review of complete resection in 22 cases, 5 cases of residual. Forty-five patients were followed up for one year. The MRI findings were similar to those of six months after operation. Conclusion Six months after operation, MRI can better judge the effect of surgery and is beneficial to the choice of postoperative adjuvant therapy.