常规垂体磁共振成像表现阴性的 ACTH 腺瘤 1 例
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中南大学湘雅医院放射科

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ACTH-secreting adenomas with no visible tumor on conventional pituitary MRI: A case report
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中南大学湘雅医院放射科

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    摘要:

    库欣病是一种罕见的神经内分泌疾病,其发病率为 1.2-2/100 万人每年,其最 常见的病因为促肾上腺皮质激素细胞腺瘤。ACTH 腺瘤以横径 10mm 为界限,分为大腺瘤和 微腺瘤,其中对于直径小于 6mm 的微腺瘤,常规垂体磁共振成像可为阴性表现。本院于 2018 年至 2022 年 3 月确诊了 9 例 ACTH 腺瘤患者,其中有 6 例常规垂体磁共振成像诊断为微腺 瘤,1 例为大腺瘤,2 例为阴性表现。其中 1 例常规垂体磁共振成像诊断阴性的病例,在后 续前循环血管高分辨成像上存在阳性发现,由于其为直径 2mm 的微小结节,在常规磁共振 成像上难以辨别。该患者于 2021 年 11 月 1 日行神经内镜下颅底肿瘤切除术,病理证实前 循环血管高分辨所示垂体右前份结节为 ACTH 腺瘤。作为一种罕见的神经内分泌肿瘤,ACTH 腺瘤的早期诊断对临床是否手术等后续治疗方案的选择极具意义。磁共振血管高分辨成像对 于垂体微小腺瘤的诊断可能具有辅助价值。

    Abstract:

    Cushing's disease is a rare neuroendocrine disorder with an incidence of (1.2- 2) ×10 -6 per year,and the most common cause of CD is ACTH-secreting adenoma. ACTH-secreting adenomas which smaller than 10mm are regarded as microadenomas. For those smaller than 6mm, conventional pituitary magnetic resonance imaging cannot visible. During 2018 to March 2022, there are 9 patients diagnosed as ACTH-secreting adenomas in our hospital, of which 6 patients were diagnosed as microadenomas by conventional pituitary magnetic resonance imaging and 1 patient were macroadenomas. Between 2 patients with no visible tumors though conventional MRI, one patient showed a tiny nodule with a diameter of 2mm on high-resolution vessel wall imaging (HR-VWI), which was difficult to be seen on conventional pituitary MRI. On November 1, 2021, the patient underwent neuro-endoscopic tumor resection surgery and the right anterior pituitary nodule shown in HR-VWI was confirmed by pathology to be ACTH-secreting adenoma. As a rare neuroendocrine tumor, the early diagnosis of ACTH adenoma is of great significance for the follow-up treatment selections. HR-VWI would be helpful in the diagnosis of pituitary microadenoma.

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  • 收稿日期:2022-05-15
  • 最后修改日期:2022-06-22
  • 录用日期:2022-06-24
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