MRI及扩散加权成像对微囊型脑膜瘤与非典型脑膜瘤的鉴别诊断价值  

Magnetic Resonance Imaging and Diffusion Weighted Imaging in the Differential Diagnosis of Microcystic Meningioma and Atypical Meningioma

作　　者：孙秋[1] 柯晓艾 周青 韩蕾 周俊林[1] SUN Qiu;KE Xiaoai;ZHOU Qing;HAN Lei;ZHOU Junlin(Department of Radiology,Lanzhou University Second Hospital,the Second Clinical School,Lanzhou University,Key Laboratory of Medical Imaging of Gansu Province,Lanzhou 730030,China)

机构地区：[1]兰州大学第二医院放射科,兰州大学第二临床医学院,甘肃省医学影像重点实验室,甘肃兰州730030

出　　处：《中国医学影像学杂志》2020年第7期493-498,共6页Chinese Journal of Medical Imaging

基　　金：甘肃省卫生行业科研计划资助项目(GSWSKY2018-52)。

摘　　要：目的采用常规MRI及扩散加权成像(DWI)鉴别诊断微囊型脑膜瘤(MCM)与非典型脑膜瘤(AM),以提高术前诊断准确率。资料与方法回顾性分析经手术病理证实的25例MCM患者与50例AM患者的术前临床、影像及病理资料,比较两种病理亚型脑膜瘤的MRI征象及所测表观扩散系数(ADC)值,采用受试者工作特征(ROC)曲线评估各参数鉴别两组肿瘤的诊断效能。结果MCM组与AM组具有分叶征者分别占24%(6/25)和74%(37/50),发生囊变者分别占76%(19/25)和52%(26/50),瘤脑界面模糊者分别占16%(4/25)和52%(26/50),差异均有统计学意义(P<0.05);MCM组瘤周水肿无-轻度、中度、重度者分别占68%(17/25)、24%(6/25)、8%(2/25),AM组分别占24%(12/50)、40%(20/50)、36%(18/50),差异有统计学意义(P<0.05)。MCM组的ADC值为(1.01±0.12)×10^-3 mm^2/s,相对ADC(rADC)值为1.42±0.18,均高于AM组的ADC值[(0.78±0.10)×10^-3 mm^2/s]及rADC值(1.08±0.12),差异有统计学意义(P<0.01)。当ADC阈值取0.91×10^-3 mm^2/s时,其鉴别诊断MCM与AM的敏感度为88%,特异度为92%;rADC阈值取1.10时,其鉴别诊断MCM与AM的敏感度为100%,特异度为84%。结论与AM相比,MCM的瘤脑界面更清晰,瘤周水肿更轻,分叶征少见且更易发生囊变,结合DWI中的定量参数可有效鉴别MCM与AM,具有一定的临床应用价值。Purpose To use conventional MRI and diffusion weighted imaging(DWI)to differentially diagnose microcystic meningioma(MCM)from atypical meningioma(AM),and to improve the accuracy of preoperative diagnosis.Materials and Methods The preoperative clinical data,images and pathological data of 25 patients with MCM confirmed by surgery and pathology and 50 patients with AM were retrospectively analyzed.MRI features and apparent diffusion coefficient(ADC)of the two pathological subtypes of meningioma were compared.Receiver operating characteristic(ROC)curve was used to evaluate the diagnostic efficacy of each parameter in identifying the two groups of tumors.Results In MCM group and AM group,24%(6/25)and 74%(37/50)had lobules,76%(19/25)and 52%(26/50)had cystic degeneration,16%(4/25)and 52%(26/50)had blurred tumor brain interface,and the differences were statistically significant(P<0.05).Peri-tumor edema mild,moderate and severe MCM accounted for 68%(17/25),24%(6/25)and 8%(2/25),and AM accounted for 24%(12/50),40%(20/50)and 36%(18/50),respectively.The difference was statistically significant(P<0.05).ADC value and rADC value of MCM group were(1.01±0.12)×10^-3 mm^2/s and 1.42±0.18,respectively;which were statistically higher than those of AM group of(0.78±0.10)×10^-3 mm^2/s and 1.08±0.12(P<0.01).When ADC value threshold was 0.91×10^-3 mm^2/s,the sensitivity for differential diagnosis of MCM and AM was 88%,and the specificity was 92%.For rADC value threshold,1.10 was used for differential diagnosis of MCM and AM.The sensitivity and specificity were 100%and 84%,respectively.Conclusion Compared with AM,the tumor-brain interface of MCM is clearer,peritumoral edema is lighter,lobular signs are rare,and cystic change is more likely to occur.Combining the quantitative parameters in DWI can effectively distinguish MCM from AM,which has certain clinical application value.

关 键 词：脑膜瘤 磁共振成像 扩散加权成像 表观扩散系数 诊断 鉴别 

分 类 号：R739.45[医药卫生—肿瘤] R730.42[医药卫生—临床医学]