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Knosp分级

已有 209 次阅读2021-3-30 11:14 |系统分类:医学科学

Knosp分级
垂体腺瘤五级分类法:采用海绵窦冠状位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。

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; 

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回复 hyc3140 2021-3-30 11:43
the degree of contrast enhancement of the tumor (dCt) was calculated according to literature findings, a dCt less than 25 was graded mild enhancement, a dCt between 25-50 was graded as moderate enhancement,and a dCt of more than 50 was graded as marked enhancement.
回复 hyc3140 2021-3-30 11:43
Holodny AI, Nusbaum AO, Festa S, Pronin IN, Lee HJ, Kalnin AJ. Correlation between the degree of contrast enhancement and the volume of peritumoral edema in meningiomas and malignant gliomas. Neuroradiology 1999;41:820-825
Zhang D, Hu LB, Henning TD, et al. MRI findings of primary CNS lymphoma in 26 immunocompetent patients[J]. Korean journal of radiology, 2010,11:269-277.

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