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垂体瘤侵袭性分级——Knosp分级

热度 1已有 341 次阅读2021-8-9 17:29 |个人分类:医学影像|系统分类:医学科学| 垂体瘤


垂体瘤非常常见,有的医院每天都要报好几例,今天和大家讲一讲垂体瘤侵袭性分级。
最常用的是Knosp垂体腺瘤五级分类法:采用测量海绵窦冠状位MRI上垂体腺瘤与颈内动脉海绵窦段(C4)及床突上段(C2)血管管径的连线,来判断垂体腺瘤与海绵窦的关系。

0级(正常型):海绵窦形态正常,有海绵窦静脉丛的强化,肿瘤未超过C2-C4血管管径的内切连线。
1级:肿瘤超过C2-C4血管管径的内切连线,但没有超过C2-C4血管管径的中心连线,海绵窦内侧部静脉丛消失。


2级:肿瘤超过C2-C4血管管径的中心连线,但没有超过C2-C4血管管径的外切连线,可致海绵窦上部或下部静脉丛消失。


3级:肿瘤超过C2-C4血管管径的外切连线,海绵窦内侧、上部和/或下部静脉丛消失,其外侧静脉丛也可消失。


4级:海绵窦段颈内动脉被完全包裹,导致内径狭窄,各部静脉丛消失,海绵窦的上壁和外壁呈球形向外扩展突出。


影像学上侵袭性垂体腺瘤的诊断还有比较常用的Hardy-Wilson分级法。

Fig. 1. Graphic schemes (left), coronal MR images (center), and endoscopic views (right).  A: Grade 0: the adenoma does not encroach on the CS space. Thus, the tangent of the medial aspects of the intracavernous and supracavernous ICAs is not passed.44 B: Grade 1: the medial tangent is passed, but the extension does not go beyond a line drawn between the crosssectional centers of the intracavernous and supracavernous ICAs (the intercarotid line).44 C: Grade 2: the tumor extends beyond the intercarotid line but not past the tangent on the lateral aspects of the intracavernous and supracavernous ICAs.44 D: Grade 3A: the tumor extends lateral to the lateral tangent of the intracavernous and supracavernous ICAs into the superior CS compartment.44 E: Grade 3B: the tumor extends lateral to the lateral tangent of the intracavernous and supracavernous ICAs into the inferior CS compartment.  F: Grade 4: there is total encasement of the intracavernous carotid artery.44 AD = adenoma; LCSW = lateral CS wall (seen after removing the medial CS wall); MCSW = medial CS wall; PT = pituitary gland. The asterisk indicates an invaded medial CS wall, and arrows indicate trabeculae. Copyright Engelbert Knosp. Published with permission.


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回复 hyc3140 2021-8-9 17:41
We present 25 pituitary adenomas that were confirmed surgically to have invaded the cavernous sinus space. The surgical results are compared with the preoperative magnetic resonance imaging findings. For comparable radiological criteria, we classified parasellar growth into five grades. This proposed classification is based on coronal sections of unenhanced and gadolinium diethylene-triamine-pentaacetic acid enhanced magnetic resonance imaging scans, with the readily detectable internal carotid artery serving as the radiological landmark. The anatomical, radiological, and surgical conditions of each grade are considered. Grades 0, 1, 2, and 3 are distinguished from each other by a medial tangent, the intercarotid line--through the cross-sectional centers--and a lateral tangent on the intra- and supracavernous internal carotid arteries. Grade 0 represents the normal condition, and Grade 4 corresponds to the total encasement of the intracavernous carotid artery. According to this classification, surgically proven invasion of the cavernous sinus space was present in all Grade 4 and Grade 3 cases and in all but one of the Grade 2 cases; no invasion was present in Grade 0 and Grade 1 cases. Therefore, the critical area where invasion of the cavernous sinus space becomes very likely and can be proven surgically is located between the intercarotid line and the lateral tangent, which is represented by our Grade 2. We also measured tumor growth rates, using the monoclonal antibody KI-67, which shows a statistically higher proliferation rate (P < 0.001) in adenomas with surgically observed invasion into the cavernous sinus space, as compared with noninvasive adenomas.

Knosp E, Steiner E, Kitz K, Matula C. Pituitary adenomas with invasion of the cavernous sinus space: a magnetic resonance imaging classification compared with surgical findings. Neurosurgery. 1993 Oct;33(4):610-7; discussion 617-8. doi: 10.1227/00006123-199310000-00008. PMID: 8232800.
回复 hyc3140 2021-8-9 18:12
Micko AS, Wöhrer A, Wolfsberger S, Knosp E. Invasion of the cavernous sinus space in pituitary adenomas: endoscopic verification and its correlation with an MRI-based classification. J Neurosurg. 2015 Apr;122(4):803-11. doi: 10.3171/2014.12.JNS141083. Epub 2015 Feb 6. PMID: 25658782.
回复 admin 2021-8-15 23:03
https://mp.weixin.qq.com/s/XaRTxkY-9ShQG06nQhnU8w

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