3.0T磁共振多模态成像对脑胶质母细胞瘤和单发脑转移瘤的鉴别诊断价值  

The Diagnostic Value of 3.0 T Multi-Modal MRI in Differentiating Glioblastoma and Single Brain Metastases

作　　者：邬裕樊 李忠明[1] 翁强 陈德华[1] 邢振[1] 曹代荣[1,2] WU Yufan;LI Zhongming;WENG Qiang(Department of Radiology,the First Affiliated Hospital of Fujian Medical University,Fuzhou,Fujian Province 350005,P.R.China)

机构地区：[1]福建医科大学附属第一医院影像科,福州350005 [2]福建医科大学附属第一医院福建省肿瘤精准诊疗重点实验室,福建医科大学附属第一医院放射生物福建省高校重点实验室,福州350005

出　　处：《临床放射学杂志》2021年第9期1660-1665,共6页Journal of Clinical Radiology

摘　　要：目的探讨3.0 T磁共振多模态成像平扫、增强、表观扩散系数(ADC)值及磁敏感加权成像(SWI)对胶质母细胞瘤(GBM)和单发脑转移瘤(BM)的鉴别诊断价值。方法分析经手术病理证实34例GBM和31例单发BM,术前行常规MRI平扫、增强、DWI及SWI扫描,选取感兴趣区(肿瘤实性区、瘤周水肿区、正常脑实质区),测量瘤体最大直径、瘤体及瘤周ADC值、瘤体T2WI信号/白质信号比值、瘤体最厚壁/坏死区比值、增强瘤体/白质信号比值、磁敏感信号强度分级,比较两组多模态MRI参量差异,有统计学意义的变量绘制受试者工作特征(ROC)曲线并评估在两组中的鉴别效能。结果两组肿瘤形态、出血及强化方式差异有统计学意义(P<0.05);GBM组瘤体实性部分ADC值低于单发BM组,GBM组瘤体最大直径大于单发BM组,GBM组瘤体最厚壁/坏死区直径比值小于单发BM组,GBM组瘤体实性部分T2WI信号/白质信号比值高于单发BM组,各参量差异均有统计学意义(P<0.05)。ROC曲线提示瘤体T2WI信号/白质信号截断值1.908,曲线下面积(AUC) 0.770,敏感性97.10%,特异性51.60%,约登指数0.487;瘤体最大径截断值4.150 cm, AUC 0.707,敏感性61.80%,特异性77.4%,约登指数0.392;瘤体最厚壁/坏死区截断值0.537,AUC 0.978,敏感性1,特异性94.1%,约登指数0.941;瘤体实性部分ADC值截断值916.50×10^(-3)mm^(2)/s, AUC 0.643,敏感性41.9%,特异性91.20%,约登指数0.331;近瘤旁水肿区ADC值截断值1478.00×10^(-3)mm^(2)/s, AUC 0.676,敏感性70.97%,特异性70.59%,约登指数0.416。结论 3.0 T磁共振常规平扫、增强、DWI及SWI多模态成像对GBM和单发BM鉴别诊断具有较高临床实用价值。Objective To investigate the diagnostic value of 3.0 T multi-modal MRI in differentiating glioblastoma(GBM) and single brain metastases(BM). Methods 34 patients with GBM and 31 patients with BM confirmed by pathology were analyzed retrospectively. All patients underwent T2 weighted imaging( T2WI),diffusion weighted imaging( DWI),enhanced MRI scan and susceptibility weighted imaging( SWI) preoperatively. The mean apparent diffusion coefficient( ADCmean) of tumorous parenchyma and peritumoral edema were measured;intratumoral susceptibility signal intensity of that was graded;the T2WI and enhance signal intensity of tumorous parenchyma and gray matter. Differences of multimodal MRI parameters were statistically inspected. ROC curve was used to evaluate diagnostic efficiency,in order to obtain threshold,sensitivity,specificity. Results There were statistically significant differences in the morphology,bleeding and enhancement mode between the two groups( P < 0. 05). The ADC value of the solid part of the tumor in GBM group was lower than that in BM group,the thickest wall/necrosis area diameter ratio of the tumor in GBM group was lower than that in BM group,the maximum diameter of the tumor in GBM group was greater than that in BM group,and the T2WI signal/white matter signal ratio of the solid part of the tumor in GBM group was higher than that in BM group,and the differences of all parameters were statistically significant. ROC curve analysis showed that when the tumor T2WI signal/white matter signal was 1. 908,the AUC was 0. 770,the sensitivity was 97. 10%,the specificity was 51. 60%,and Youden index 0. 487. When the maximum diameter of the tumor was 4. 150 cm,the AUC was 0. 707,the sensitivity was 61. 8%,the specificity was77. 4%,and the Youden index was 0. 392. When the thickest wall/necrotic area of the tumor was 0. 537,AUC was 0. 978,sensitivity was 1,and specificity was 94. 1%,and Youden index was 0. 941. When the tumor solid part ADC value was916. 50 × 10^(-3) mm^(2)/s,AUC was 0. 4643,sensitivity was 41. 9%

关 键 词：胶质母细胞瘤 脑转移瘤 扩散加权成像 磁敏感加权成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R739.41[医药卫生—诊断学]