Monitoring value of MRI in the diagnosis and treatment of growth hormone deficiency in children
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摘要:
目的 探究MRI对生长激素缺乏症患儿的诊断及治疗的监测价值。 方法 回顾性分析2018年1月~2019年4月本院就诊的100例生长激素缺乏症患者的临床资料，比较患者的血清生长激素水平，采用8通道颅脑线圈对所有患者进行核磁共振平面扫描，比较分析患者治疗前后垂体MRI图像变化。 结果 在100例生长激素缺乏症患者中，45例患者生长激素峰值低于5~10 μg/L，55例生长激素峰值在5 μg/L以下。100例生长激素缺乏症的患者垂体病变以垂体前叶发育不良为主，共42例（42%），再者是垂体柄中断综合征25例（25%）；空蝶鞍综合征14例（14%），郎格汉斯细胞组织增多症侵袭垂体12例（12%）以及颅咽管瘤7例（7%）。生长激素缺乏症的患儿垂体的矢状高径、矢状后径等指标大于正常儿童，且差异具有统计学意义（P < 0.05），经生长激素替代治疗后，各个年龄的垂体都有不同程度的变小，其中以3~10岁和11~16岁的变化更加显著（P < 0.05）。 结论 MRI能够准确发现由于垂体病变导致的生长激素缺乏症，同时也能准确的监测生长激素替代治疗后垂体大小的改变。 Abstract:Objective To explore the monitoring value of MRI in the diagnosis and treatment of growth hormone deficiency in children. Methods We retrospectively analyzed the clinical data of 100 patients with growth hormone deficiency in our hospital from January 2018 to April 2019. The serum growth hormone levels of all patients were analyzed. The changes of pituitary MRI images before and after treatment were compared. Results Among the 100 cases of growth hormone deficiency, 45 cases had the peak value of growth hormone less than 5-10 μg/L and 55 cases had the peak value of growth hormone less than 5 μg/L. In the 100 patients with growth hormone deficiency, the main pituitary lesion was anterior pituitary dysplasia (n= 42, 42%), and pituitary stalk interrupt syndrome (n=25, 25%). In addition, 14 cases of empty sella syndrome (14%), long disease of grow in quantity of Hans cells invasive pituitary 12 cases (12%) and 7 cases of craniopharyngioma (7%). Children with growth hormone deficiency of pituitary high sagittal diameter, sagittal diameter after index greater than normal children, and the difference was statistically significant (P < 0.05). After growth hormone replacement therapy, The pituitary gland was smaller in different degrees at all ages, and the change was more significant at 3 - 10 years old and 11 - 16 years old (P < 0.05). Conclusion MRI can accurately detect growth hormone deficiency caused by pituitary disease, and can also accurately monitor the change of pituitary size after growth hormone replacement therapy. -
图 1 垂体前叶发育不良影像学特征
A: 生长激素缺乏症患儿矢状位图; B: 生长激素缺乏症患儿冠状位图.
Figure 1. Imaging features of anterior pituitary hypoplasia.
图 2 生长激素缺乏症患儿治疗前后垂体的变化
A: 生长激素缺乏症患儿治疗前矢状位图; B: 生长激素缺乏症患儿治疗前冠状位图; C: 生长激素缺乏症患儿治疗后矢状位图; D: 生长激素缺乏症患儿治疗后冠状位图.
Figure 2. Changes of pituitary in children with growth hormone deficiency before and after treatment.
表 1 生长激素治疗前后垂体大小比较
Table 1. Comparison of pituitary size before and after growth hormone treatment (Mean±SD)
经线 治疗前 治疗后 3~10岁 11~16岁 17~21岁 3~10岁 11~16岁 17~21岁 矢状高径 3.81±0.18# 3.71±0.23# 3.86±0.11# 3.41±0.12* 3.01±0.11* 3.11±0.01* 矢状后径 7.23±1.11# 7.26±1.32# 7.93±1.47# 7.03±1.01* 7.06±0.42* 7.01±1.01* 冠状高径 3.87±0.23# 3.65±0.24# 3.47±0.39# 3.21±0.17* 3.45±0.21 3.21±0.11* 冠状宽径 10.23±1.21# 10.8±1.26# 9.21±1.31# 10.03±1.23 9.74±1.01* 8.21±1.11* #P < 0.05 vs正常儿童; *P < 0.05 vs治疗前. 
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