A Study On The Clinical Significance Of Pituitary Microadenoma And Pituitary Signal Unevenness And The Clinical Application Of Dynamic Contrast-enhanced MRI

Objectives： To analyze the pituitary imaging characteristics of pituitarymicroadenoma and pituitary signal unevenness patients under the dynamiccontrast-enhanced MRI, as well as the changes in its target hormone, immuneparameters, biochemical indexes. Make a contrastive analysis on thecharacteristics of peak time and time-signal intensity curve respectively in thenormal pituitary microadenoma and pituitary signal unevenness. Explore theclinical significance of pituitary microadenoma and pituitary signal unevenness,which will provide a basis for clinical diagnosis.Material and methods： it is required to analyze the patients who receivepituitary non-enhanced and dynamic contrast-enhanced MRI treatment inCardio-Cerebrovascular Disease Hospital affiliated to Ningxia Medical Universityfrom March2011to June2013, and provide complete clinical and laboratory data.Based on the performance of MRI and standards on diagnosis, inclusion andexclusion, pituitary signal unevenness patients (42cases) and pituitarymicroadenoma (59cases) are selected as the case group, healthy volunteers areselected from the patients with non-saddle lesions as normal control group (30cases). For those who receive repeat treatment, it mainly focuses on the data offirst treatment. The study is made on the characteristics of clinical manifestationof different group, the pituitaries such as FSH, LH, T, P, E2, PRL, COR (8AM),TSH, FT3, FT4, ESR, CRP, ANA, K, Na, etc., hormone, immune, electrolytes and other indexes of target gland indexes. Meanwhile, FUNCTOOL is adopted to drawthe time-signal intensity curve of dynamic enhancement of pituitary and measureits peak time. SPSS17.0software is also used for data statistics and dataprocessing.Results：1. Fatigue and anepithymia are the most common symptoms inpituitary microadenoma and pituitary signal unevenness group (pituitarymicroadenoma group accounts for45.8%, while the pituitary signal unevennessaccounts for38.1%).2. There are significant differences in LH and P indexesamong the normal group, signal unevenness group and microadenoma group (P <0.05), whereas there is no difference in the FSH, T, PRL and E2(P>0.05).3.There exist significant differences in FT3among the normal group, signalunevenness and microadenoma group (P <0.05), whereas there exists nodifference in FT4and TSH among the three groups (P>0.05).4. There is nosignificant difference in COR (8am) among the three groups (P>0.05).5. Thereis no significant difference in K and Na among the three groups (P>0.05).6.There is no significant difference in ESR, CRP and ANA among the three groups(P <0.05).7. The peak time of normal pituitary tissue is52.54±17.59s, peak timeof microadenoma is96.08±28.59s, and peak time of pituitary signal unevenness is77.13±27.10s. The peak time of the three groups is quite different, which isbetween normal pituitary and microadenoma. There are differences between thethree groups (P<0.05).8. I-Curve is more common in normal pituitary tissue(70%); III-Curve is only in the pituitary signal unevenness （7.1%） andmicroadenoma group (25.4%), especially in microadenoma group. II-Curve ismainly in pituitary signal unevenness (73.8%). The time-signal curves amongthese three groups are quite different among the three groups (P<0.05).Conclusion：1. Pituitary microadenoma and pituitary signal unevenness can cause pituitary hypofunction. Target gland damage of patients may lead tohormonal changes, high hormone level or normal hormone level, which aredetermined by hypothalamus-pituitary-adrenal axis, the thyroid gland axis orgonad axis.2. Anterior pituitary hypofunction caused by pituitary signalunevenness may damage adrenal gland, thyroid gland and gonads, but it dependson patients.3. Pituitary signal unevenness may be influenced by immuneinflammation factors, but it still needs specific antibody detection.4. In the earlystage of the Dynamic MRI, scan immediately after intravenous injection ofcontrast agent Gd-DTPA, which is quite important for detecting the detection ofpituitary microadenoma and pituitary signal unevenness, and increasing thedetection rate of lesions.5. Pituitary signal unevenness tissue is weak in bloodsupply and vascular permeability，but better than those of pituitary microadenomas.6. The peak time and time-signal intensity curve of Dynamic Contrast-EnhancedMRI play an irreplaceable role for the detection and differential diagnosis ofpituitary microadenoma and pituitary signal unevenness.