多模态磁共振对PCNSL和GBM的鉴别诊断研究  

Differential diagnosis of primary central nervous system lymphoma and glioblastoma by multimodal MRI

作　　者：权建平[1] 罗一博 QUAN Jian-ping;LUO Yi-bo(Department of Medical Imaging,Baoji People's Hospital,Baoji 721000,Shaanxi,CHINA)

机构地区：[1]宝鸡市人民医院医学影像科,陕西宝鸡721000

出　　处：《海南医学》2021年第24期3230-3234,共5页Hainan Medical Journal

摘　　要：目的探讨多模态核磁共振(MRI)对原发性中枢神经系统淋巴瘤(PCNSL)和胶质母细胞瘤(GBM)的鉴别诊断效果。方法回顾性分析2018年2月至2020年2月期间宝鸡市人民医院收治的经手术最终确诊的41例PCNSL(PCNSL组)与41例GBM(GBM组)患者的临床资料。所有患者入院后均进行常规MRI检查、弥散加权成像(DWI)、磁敏感加权成像(SWI)以及动态磁敏感对比增强灌注成像(DSC-PWI),比较两组患者的肿瘤平均表观扩散系数值(ADC_(mean))、磁敏感信号强度(ITSS)分级、脑血容量平均值比值(rCBV_(mean)),采用受试者工作特征曲线(ROC曲线)评价诊断效能。结果PCNSL组患者的ADC_(mean)、ITSS分级、rCBV_(mean)值分别为(0.68±0.07)×10^(-3)mm^(2)/s、(0.77±0.12)级、(1.76±0.30),明显低于GBM组的(0.89±0.22)×10^(-3)mm^(2)/s、(2.51±0.55)级、(3.53±0.79),差异均有统计学意义(P<0.05);经ROC曲线分析,单参量时,ITSS级的敏感度、特异性、准确率、AUC面积分别为90.11%、96.21%、86.36%、0.967,ADC_(mean)的敏感度、特异性、准确率、AUC面积分别为100.00%、72.55%、72.55%、0.902,r CBV_(mean)的敏感度、特异性、准确率、AUC面积分别为95.76%、92.10%、86.66%、0.974,三者相比ITSS级效能明显高于ADC_(mean)和r CBV_(mean),差异均有统计学意义(P<0.05);多参量时,联合ADC_(mean)、ITSS的敏感度、特异性、准确率、AUC面积分别为100.00%、92.12%、92.12%、0.974,联合ITSS、r CBV_(mean)的敏感度、特异性、准确率、AUC面积分别为100.00%、96.69%、96.69%、0.996,联合ADC_(mean)、r CBV_(mean)的敏感度、特异性、准确率、AUC面积分别为95.01%、96.02%、91.03%、0.986,联合ITSS、ADC_(mean)、r CBV_(mean)的敏感度、特异性、准确率、AUC面积分别为100.00%、96.69%、96.69%、0.996,四者相比,联合ITSS、r CBV_(mean)与联合ITSS、ADC_(mean)、r CBV_(mean)的效能一致且明显高于联合ADC_(mean)、ITSS与联合ADC_(mean)、r CBV_(mean)及ITSS分级的效能,差异均�Objective To investigate the effect of multimodal magnetic resonance imaging(MRI)in the differential diagnosis of primary central nervous system lymphoma(PCNSL)and glioblastoma(GBM).Methods The clinical data of 41 patients with PCNSL(PCNSL group)and 41 patients with GBM(GBM group)finally diagnosed by surgery in Baoji People’s Hospital from February 2018 to February 2020 were analyzed retrospectively.After admission,all patients underwent routine MRI,diffusion weighted imaging(DWI),magnetic sensitivity weighted imaging(SWI),and dynamic magnetic sensitivity contrast-enhanced perfusion imaging(DSC-PWI).The average apparent diffusion coefficient(ADC_(mean)),magnetic sensitivity signal intensity(ITSS)grade,and _(mean) cerebral blood volume ratio(rCBV_(mean))were obtained,Receiver operating characteristic curve(ROC curve)was used to evaluate the diagnostic efficacy.Results ADC_(mean),ITSS grade,and rCBV_(mean)of PCNSL group were(0.68±0.07)×10^(-3)mm^(2)/s,0.77±0.12,and 1.76±0.30,respectively,which were significantly lower than(0.89±0.22)×10^(-3)mm^(2)/s,2.51±0.55,and 3.53±0.79 of GBM group(P<0.05).ROC curve analysis showed that the sensitivity,specificity,accuracy,and AUC of ITSS grade were90.11%,96.21%,86.36%,0.967,respectively,those of ADC_(mean)were 100.00%,72.55%,72.55%,0.902,and those of rCBV_(mean)were 95.76%,92.10%,86.66%,0.974,respectively;the efficiency of ITSS grade was significantly better than that of the other two(P<0.05).For multi-parameters,the sensitivity,specificity,accuracy,and AUC were 100.00%,92.12%,92.12%,0.974 for ADC_(mean)combined with ITSS,respectively,100.00%,96.69%,96.69%,and 0.996 for ITSS combined with rCBV_(mean),95.01%,96.02%,96.02%,and 0.986 for ADC_(mean)combined with rCBV_(mean),and 100.00%,96.69%,96.69%,and 0.996 for combination of ITSS,ADC_(mean),rCBV_(mean);the efficacy of ITSS combined with r CBV_(mean) was consistent with that of the combination of ITSS,ADC_(mean),rCBV_(mean),which was significantly better than that of ADC_(mean)combined with ITSS and that of the combina

关 键 词：原发性中枢神经系统淋巴瘤 胶质母细胞瘤 多模态核磁共振 弥散加权成像 磁敏感加权成像 动态磁敏感对比增强灌注成像 诊断效能 

分 类 号：R730.26[医药卫生—肿瘤]