电子计算机体层扫描平扫对鉴别脑内肿瘤及非肿瘤性病变价值的研究  

The value of unenhanced computed tomography in differentiating brain tumors from non-neoplastic lesions

作　　者：郭永华 吴晓冬[2] 展金锋[1] 董诚[1] 刘学军[1] 周锐志[1] 刘松[1] Guo Yonghua;Wu Xiaodong;Zhan Jinfeng;Dong Cheng;Liu Xuejun;Zhou Ruizhi;Liu Song(Department of Radiology,the Affiliated Hospital of Qingdao University,Qingdao 266000,China;Organ Transplant Center,the Affiliated Hospital of Qingdao University,Qingdao 266000,China)

机构地区：[1]青岛大学附属医院放射科,青岛266000 [2]青岛大学附属医院器官移植中心,青岛266000

出　　处：《中华神经科杂志》2022年第2期117-124,共8页Chinese Journal of Neurology

摘　　要：目的探讨电子计算机体层扫描(CT)平扫在脑内肿瘤与非肿瘤性病变鉴别诊断中的附加价值。方法回顾性收集青岛大学附属医院2016年9月至2020年10月经活组织检查(活检)或手术病理诊断的脑内肿瘤(弥漫性胶质瘤及脑内非胶质来源肿瘤)患者共237例[男性140例,女性97例,年龄(49±16)岁,其中低级胶质瘤48例、高级胶质瘤134例、原发中枢神经系统淋巴瘤38例、髓母细胞瘤9例、生殖细胞瘤5例、中枢神经细胞瘤3例]以及经活检或临床证实的脑内非肿瘤性病变患者66例[男性46例,女性20例,年龄(42±13)岁,其中脓肿12例、梗死5例、脱髓鞘病变33例、自身免疫性脑炎11例、中枢神经系统血管炎5例]。所有患者均在治疗前行常规磁共振成像(MRI)扫描及CT平扫。由2名神经影像医生共同进行图像回顾,在仅提供MRI以及同时提供MRI及CT图像的情况下进行2次盲评,分别记录诊断结果及可靠性评分,比较两种评价的准确性。结果CT平扫呈现高密度对于提示肿瘤诊断有高特异度(95%),高于常规MRI扫描(86%),但其诊断敏感度(34%)低于MRI扫描(86%)。与MRI单一检查的准确率(86%)相比,联合采用MRI扫描和CT平扫能明显提高诊断准确率(94%)。非肿瘤性病变CT值比值明显低于肿瘤组[分别为0.69(0.61,0.78)和1.14(1.00,1.25),W=2123,P<0.05]。非胶质来源肿瘤组CT值比值高于弥漫胶质瘤组且差异有统计学意义[分别为1.28(1.18,1.41)和1.13(0.97,1.21),W=1858,P<0.05]。弥漫性胶质瘤Ⅲ、Ⅳ级两组间差异不明显[分别为1.11(0.99,1.20)和1.16(1.09,1.24),P>0.05(Nemenyi检验,无检验值)],但明显高于弥漫性胶质瘤Ⅱ级[0.89(0.76,1.07),P<0.05(Nemenyi检验,无检验值)],同一级别星形细胞胶质瘤与少突胶质细胞瘤差异不明显。结论CT平扫病变区域内出现高密度影对诊断脑内肿瘤性病变具有高度特异性。对于低密度的病变,CT平扫结合常规MRI对于缩小鉴别诊断范围也有重要价Objective To investigate the additional value of unenhanced computed tomography(CT)in the differential diagnosis of brain tumors and non-neoplastic lesions.Methods A total of 237 cases[140 males and 97 females;(49±16)years old;including 48 cases of low-grade glioma,134 cases of high-grade glioma,38 cases of primary central nervous system lymphoma,9 cases of medulloblastoma,5 cases of germinoma,and 3 cases of central neurocytoma]of brain tumors(diffuse gliomas and non-glial tumors)diagnosed by biopsy or surgery and pathology in the Affiliated Hospital of Qingdao University from September 2016 to October 2020 were collected retrospectively.Sixty-six cases[46 males and 20 females;(42±13)years old;including 12 cases of abscesses,5 cases of infarcts,33 cases of demyelinating lesions,11 cases of autoimmune encephalitis,and 5 cases of central nervous system vasculitis]of brain non-neoplastic lesions were confirmed by biopsy or clinic.All patients underwent routine magnetic resonance imaging(MRI)scan and unenhanced CT before the treatment.The images were reviewed by two neuroradiologists together blind to the final diagnosis with and without CT images respectively.The diagnostic results and reliability scores were recorded,and the accuracy of the two evaluations was compared.Results CT hyperattenuation exhibited a higher specificity(95%)than conventional MRI scan(86%),and a lower diagnostic sensitivity(34%vs 86%).Compared to MRI alone,the combined modality of MRI and unenhanced CT significantly improved diagnostic accuracy(94%vs 86%).Additionally,the CT attenuation ratio of non-neoplastic lesions was significantly lower than that of neoplastic lesions[0.69(0.61,0.78)and 1.14(1.00,1.25),W=2123,P<0.05].The CT attenuation ratio in the non-glial origin tumor group was significantly higher than that in the diffuse glioma group[1.28(1.18,1.41)and 1.13(0.97,1.21),W=1858,P<0.05].There was no significant difference in gradeⅢandⅣgroups of diffuse glioma[1.11(0.99,1.20)vs 1.16(1.09,1.24),P>0.05(Nemenyi test)].However,both wer

关 键 词：脑肿瘤 神经胶质瘤 淋巴瘤 脱髓鞘自身免疫疾病 中枢神经 诊断 鉴别 磁共振成像 体层摄影扫描仪 X线计算机 

分 类 号：R739.4[医药卫生—肿瘤]