T_(2)-FLAIR增强联合T_(1)WI-3D-TFE增强序列对癌性脑膜炎的诊断价值  

Diagnostic Value of T_(2)-FLAIR Enhancement Combined with T_(1)WI-3D-TFE Enhancement Sequence on Neoplastic Meningitis

作　　者：黄钻明 王开福 徐谢生 李兴 HUANG Zuanming;WANG Kaifu;XU Xiesheng;LI Xing(Maoming Hospital of Traditional Chinese Medicine,Maoming 525000,China)

机构地区：[1]茂名市中医院,广东茂名525000

出　　处：《中外医学研究》2022年第30期60-63,共4页CHINESE AND FOREIGN MEDICAL RESEARCH

摘　　要：目的:探讨 T_(2)液体衰减翻转恢复序列( T_(2)-FLAIR)增强联合 T_(1)WI三维快速扰相梯度回波( T_(1)WI-3D-TFE)增强序列对癌性脑膜炎(neoplastic meningitis,NM)的诊断价值。方法:选取2020年12月-2022年1月茂名市中医院收治的60例疑似NM患者为试验对象。所有患者给予MRI平扫、 T_(2)-FLAIR增强序列( T_(2)检查)、 T_(1)WI-3D-TFE增强序列( T_(1)检查)和 T_(2)-FLAIR增强联合 T_(1)WI-3D-TFE增强序列(联合检查)。以临床确诊结果作为金标准,收集NM患者的临床特点,分析 T_(1)、 T_(2)、联合检查与金标准的一致性。比较 T_(1)、 T_(2)、联合检查对NM的诊断价值。结果:60例患者中27例确诊为非肿瘤性疾病,33例经临床确诊为NM。NM平均病程为(4.52±0.62)周。60例患者中肺癌15例(25.00%),黑色素瘤8例(13.33%),乳腺癌4例(6.67%),甲状腺癌3例(5.00%),胃癌3例(5.00%);头痛23例(38.33%),癫痫15例(25.00%),视力减退18例(30.00%),其他症状4例(6.67%,根性痛、听力下降、声音嘶哑等);视神经受损18例(30.00%),动眼神经受损12例(20.00%),滑车神经受损15例(25.00%),外展神经受损10例(16.67%),其他神经根受损5例(8.33%),NM患者原发疾病肺癌和黑色素瘤最为常见。 T_(2)检查与金标准一致性良好(Kappa=0.538,P<0.05);T_(1)检查与金标准一致性良好(Kappa=0.636,P<0.05);联合检查与金标准一致性较高(Kappa=0.933,P<0.05)。联合检查诊断NM的敏感度及诊断符合率高于 T_(1)、 T_(2)检查,假阴性率明显低于 T_(1)、 T_(2)检查(P<0.05)。 T_(1)检查诊断符合率(81.67%)及敏感度(75.76%)均高于 T_(2)检查,而假阴性率低于 T_(2)检查。结论:联合检查诊断NM的临床价值优于单一 T_(2)-FLAIR增强序列或 T_(1)WI-3D-TFE增强序列,其能够更好地区分NM与非NM,具有很高的临床价值,值得在临床上进一步推广使用。Objective:To investigate the diagnostic value of T_(2) fluid attenuated inversion recovery( T_(2)-FLAIR)enhancement combined with T_(1)WI three-dimensional fast-spoiled gradient echo( T_(1)WI-3D-TFE)enhancement sequence on neoplastic meningitis(NM).Method:From December 2020 to January 2022,a total of 60 suspected NM patients admitted to Maoming Hospital of Traditional Chinese Medicine were selected as the test subjects.All patients were given MRI plain scan, T_(2)-FLAIR enhanced sequence( T_(2) examination), T_(1)WI-3D-TFE enhanced sequence( T_(1) examination)and T_(2)-FLAIR enhanced combined with T_(1)WI-3D-TFE enhanced sequence(combined examination).Taking the clinically confirmed results as the gold standard.The clinical characteristics of NM patients were collected and the consistency among T_(1), T_(2),combined examination and the gold standard was analyzed.The diagnostic value of T_(1), T_(2) and combined examination for NM was compared.Result:Among the 60 patients,27 patients were diagnosed as non neoplastic diseases and 33 patients were clinically diagnosed as NM.The average course of NM was(4.52±0.62)weeks.Among the 60 patients,15 patients(25.00%)were lung cancer,8 patients(13.33%)were melanoma,4 patients(6.67%)were breast cancer,3 patients(5.00%)were thyroid cancer and 3 patients(5.00%)were gastric cancer;23 patients(38.33%)had headache,15 patients(25.00%)had epilepsy,18 patients(30.00%)had vision decreasing,4 patients(6.67%)had other symptoms(root pain,hearing loss,hoarseness,etc.);the optic nerve was damaged in 18 patients(30.00%),oculomotor nerve was damaged in 12 patients(20.00%),trochlear nerve was damaged in 15 patients(25.00%),abducent nerve was damaged in 10 patients(16.67%),and other nerve roots were damaged in 5 patients(8.33%).Lung cancer and melanoma were the most common primary disease in NM patients.Consistency analysis between T_(2) examination and gold standard was good(Kappa=0.538,P<0.05);consistency analysis between T_(1) test and gold standard was good(Kappa=0.636,P<0.05);the consist

关 键 词：癌性脑膜炎 T_(2) 液体衰减翻转恢复序列 T_(1)WI 三维快速扰相梯度回波 核磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R739.45[医药卫生—诊断学]