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Central Diabetes Insipidus in Patients without Apparent Initial MR Imaging Findings: A 2-Year Follow-Up MR Imaging Study
中央性尿崩症不明顯的初步核磁共振影像表現：兩年的核磁共振影像追蹤經驗
摘要
本研究的主要目的是介紹及討論，中央性尿崩症患者不明顯的核磁共振影像表現以及追蹤影像的變化。 本研究是壹回溯性的研究。在最近8年，共搜集26位病例，其中男性14位，女性12位，平均年齡20.1歲。診斷主要是依據DDAVP試驗以及血液-尿液之間滲透壓的關係。主要的症狀為多尿，多渴。本研究是回溯性的分析核磁共振影像表現。 26位病例中，有7位（26.9%）腦下垂體後葉的高訊號消失，有3位（11.5%）為空白蝶鞍，有1位（3.8%）腦下垂體窩變淺，有1位（3.8%）為異位性腦下垂體後葉.有6位（23%）是正常的核磁共振影像表現.有7位（26.9%）是腦下垂體蒂肥厚。 在腦下垂體蒂肥厚組的病人中，其中有5位持續變厚並接受手術組織檢體檢查，分別被診斷為生殖細胞瘤，組織細胞症及類肉瘤病。其中有2位與其他它組的病人一樣，追蹤的核磁共振影像持續不變。 在有限的經驗中，中央性尿崩症的原因相當多，在不明顯的核磁共振影像表現的病人中，持續追蹤是最重要的。特別在腦下垂體蒂持續變厚的病人，組織檢體檢查尤其重要。
並列摘要
The aim of this study is to describe the follow-up magnetic resonance imaging (MRI) findings in patients with central diabetes insipidus (CDI) patients and without having apparent initial imaging abnormality. This was a retrospective study. In the past 8 years (from 1995 to 2002), 26 patients (male 14, female 12, mean age 20.1 years) were diagnosed as CDI by water deprivation test, 1-desamino-8-D-arginine vasopressin (DDAVP) test, and the relationship between urine-plasma osmolarity. The major clinical manifestations are polyuria and polydipisia. We retrospectively analyzed the MR images. The subtle MR images included (1) loss of high signal intensity (SI) in posterior lobe on T1WI (26.9%, n=7), (2) an empty sella, (11.5%, n=3), (3) shallowing of the pituitary fossa (3.8%, n=1), (4) ectopic bright high signal intensity on T1WI at the hypothalamus (3.8%, n=1), (5) normal (23%, n=6), (6) thickened pituitary stalk thickness (PST) (26.9%, n=7). All these patients were followed at least 2 years with MR images. Seven patients were initially presented as increased pituitary stalk thickness (PST). In the following images, 5 of the seven patients had progressive thickened stalk and underwent the biopsy procedure. They were diagnosed as germinoma, histiocytosis, and sarcoidosis. Two cases of the PST group had static imaging findings in the follow-up images just as in other groups. In our limited experiences the causes of CDI were variable. It is most important to follow up the subtle MR findings. In group with progressive pituitary stalk thickness, we emphasize the necessities to make biopsy for definite diagnosis.