Dynamic susceptibility contrast enhanced MRI in differential diagnosis of glioblastoma, solitary cerebral metastasis and cerebral lymphoma

, , , , , , , *

(1.Graduate School of Tianjin Medical University, Tianjin 300060, China; 2.MRI Division, Tianjin Huanhu Hospital, Tianjin 300350, China)

Dynamic susceptibility contrast enhanced MRI in differential diagnosis of glioblastoma, solitary cerebral metastasis and cerebral lymphoma

LUHao1，2,FENGQuanzhi1,CHENGQiansheng2,DINGYan2,LIDaibin2,LIYuge2,HANBihui2,HANTong2*

(1.GraduateSchoolofTianjinMedicalUniversity,Tianjin300060,China; 2.MRIDivision,TianjinHuanhuHospital,Tianjin300350,China)

Objective To investigate the value of the dynamic susceptibility contrast enhanced MRI (DSC-MRI) in differential diagnosis of glioblastoma, solitary cerebral metastatic tumors and cerebral lymphoma. Methods Seventeen patients with glioblastoma, 15 cases with solitary cerebral metastatic tumor and 17 cases with cerebral lymphoma were analyzed retrospectively. All patients underwent conventional MR imaging, contrast-enhancement and DSC-MRI preoperatively. Pseudo color pictures of cerebral blood volume (CBV) and the time signal intensity curve were obtained from the raw data of DSC-MRI. The relative CBV (rCBV ) were measured from regions of enhanced solid parts of the tumors, peritumoral region and contralateral normal white matter regions respectively. The percentage of signal intensity recovery (PSR) of enhanced solid parts of the tumors were measured. ROC curve analysis was performed to determine optimum indicator in differential diagnosis of three types of tumors, and the sensitivity and specificity were calculated. Results Three types of tumors all showed enhancement of solid area with obvious peritumoral edema. Besides the no difference between glioblastoma and metastasis in rCBV of solid parts of the tumors, there were statistically significant differences in comparisons of two types of tumors (allP<0.05). Besides the no difference between single brain metastases and lymphoma in rCBV of peritumoral regions, there were statistically significant differences in comparisons of two types of tumors (allP<0.05). The PSR of the solid parts of the tumors had no difference between glioblastoma and single brain metastases, while there were statistically significant differences in comparisons of two types of tumors (allP<0.05). ROC curve analysis showed sensitivity and specificity of the PSR values of solid parts of the tumors in differentiating lymphoma and non lymphoma were 100% and 81.3%. The rCBV of peritumoral regions was the optimum indicator for differentiating glioblastoma and solitary brain metastasis, the sensitivity and specificity were respectively 94.1% and 86.7%. Conclusion The combination of rCBV and PSR can improve the efficiency for diagnosing the three types of brain tumors.

Glioblastoma; Single brain metastases; Lymphoma; Magnetic resonance imaging

膠質(zhì)母細(xì)胞瘤、腦轉(zhuǎn)移瘤為顱內(nèi)常見(jiàn)惡性腫瘤，腦淋巴瘤的發(fā)生率也越來(lái)越高，三者在影像上雖各有特點(diǎn)，但互有重疊，尤其病史不詳時(shí)診斷困難。由于其醫(yī)學(xué)分期、外科計(jì)劃及治療手段各不相同，故臨床上區(qū)分3種腫瘤尤為重要。動(dòng)態(tài)磁敏感對(duì)比增強(qiáng)磁共振成像(dynamic susceptibility contrast enhanced MRI, DSC-MRI)已成熟應(yīng)用于臨床，對(duì)腫瘤的診斷及鑒別診斷有重要意義，本研究旨在分析DSC-MRI鑒別診斷3種腫瘤的價(jià)值。

1 資料與方法

1.1 一般資料 收集2014年11月—2016年1月經(jīng)活檢或術(shù)后病理證實(shí)的腦腫瘤患者49例，其中膠質(zhì)母細(xì)胞瘤17例，男9例、女8例，年齡30～68歲，平均(53.3±8.2)歲；單發(fā)腦轉(zhuǎn)移瘤15例(原發(fā)腫瘤均為肺癌)，男11例、女,4例，年齡41～86歲，平均(63.6±7.3)歲，其中低分化腺癌9例、小細(xì)胞癌4例、鱗癌2例；淋巴瘤17例，男8例、女9例，年齡24～80歲，平均(58.1±15.6)歲，其中彌漫大B細(xì)胞淋巴瘤15例、濾泡性淋巴瘤1例、套細(xì)胞淋巴瘤1例。所有患者均接受常規(guī)MRI和DSC-MRI掃描，且檢查前均未接受過(guò)放化療、激素治療及手術(shù)。

1.2 儀器與方法 采用Siemens Trio A Tim 3.0T MR掃描儀。常規(guī)平掃包括軸位SE序列T1WI(TR 195.0 ms，TE 4.8 ms)，軸位FSE序列T2WI(TR 4 000 ms，TE 98.0 ms)，軸位FLAIR序列(TR 8 200 ms，TE 84.0 ms)，矢狀位SE序列T1WI(TR 550.0 ms，TE 8.4 ms)，T1WI增強(qiáng)掃描(TR 550.0 ms，TE 8.4 ms)。T2*DSC灌注掃描采用SE-EPI序列，層面選擇同增強(qiáng)前T1WI軸位掃描，成像時(shí)間1 min 39 s，TR 1 840 ms，TE 32 ms，層厚6 mm，層數(shù)17層，F(xiàn)OV 230 mm×230 mm，矩陣128×128，帶寬1 346 Hz/Px，翻轉(zhuǎn)角90°，NEX 1次，掃描至第5個(gè)時(shí)相時(shí)以高壓注射器經(jīng)肘前靜脈團(tuán)注Gd-DTPA (0.2 mmol/kg體質(zhì)量)，注射速率3 ml/s，共掃描50個(gè)時(shí)相，獲得850幅灌注原始圖。

1.3 圖像處理及數(shù)據(jù)分析 在工作站應(yīng)用Perfusion MR軟件處理DSC-MRI的原始數(shù)據(jù)，獲取腦血容量(cerebral blood volume， CBV)偽彩圖。將腫瘤實(shí)質(zhì)最高灌注區(qū)定義為瘤體區(qū)；將對(duì)比劑強(qiáng)化T1WI勾勒的強(qiáng)化腫瘤邊界以外、長(zhǎng)T2高信號(hào)水腫區(qū)且距腫瘤強(qiáng)化邊緣1 cm范圍內(nèi)定義為瘤周區(qū)。瘤體區(qū)、瘤周區(qū)最高灌注處及病變對(duì)側(cè)正常腦白質(zhì)區(qū)分別放置ROI，范圍為5～10個(gè)體素，瘤體區(qū)ROI盡量避開(kāi)腫瘤出血、壞死區(qū)及粗大血管。放置瘤周區(qū)ROI時(shí)還應(yīng)注意圓形ROI邊緣距增強(qiáng)腫瘤強(qiáng)化區(qū)的外緣至少5 mm，以除外部分容積效應(yīng)的影響；并在滿足上述條件的前提下，ROI應(yīng)盡量靠近腫瘤。測(cè)量ROI的CBV值并計(jì)算相對(duì)CBV(rCBV)值，計(jì)算公式為：瘤周或瘤體rCBV=瘤周或瘤體CBV/對(duì)側(cè)正常白質(zhì)區(qū)CBV。應(yīng)用Mean Curve軟件重建ROI時(shí)間-信號(hào)強(qiáng)度曲線，分別獲得瘤體對(duì)比劑流入前信號(hào)強(qiáng)度(SIpre)、信號(hào)下降最明顯處信號(hào)強(qiáng)度(SImin)及對(duì)比劑首過(guò)后的信號(hào)強(qiáng)度(SIpost)，并計(jì)算瘤體的信號(hào)強(qiáng)度恢復(fù)百分比(percentage of signal intensity recovery, PSR)：PSR=(SIpost-SImin)/(SIpre-SImin)×100%。

1.4 統(tǒng)計(jì)學(xué)分析 采用SPSS 19.0統(tǒng)計(jì)分析軟件。計(jì)量資料以±s表示。3種腫瘤瘤體rCBV、瘤周rCBV、瘤體PSR的比較采用單因素方差分析，方差齊性檢驗(yàn)采用Levene檢驗(yàn)，若方差齊，兩兩比較采用LSD檢驗(yàn)；若方差不齊，則采用Dunnett'st檢驗(yàn)，P<0.05為差異有統(tǒng)計(jì)學(xué)意義。應(yīng)用ROC曲線分析瘤體rCBV、瘤周rCBV、瘤體PSR鑒別診斷淋巴瘤與非淋巴瘤的效能及膠質(zhì)母細(xì)胞瘤與單發(fā)腦轉(zhuǎn)移瘤的效能。曲線下面積(area under curve, AUC)為0.5～1.0時(shí)為具有診斷價(jià)值，計(jì)算具有診斷價(jià)值指標(biāo)的最佳界值點(diǎn)、診斷敏感度和特異度。

2 結(jié)果

2.1 常規(guī)平掃及增強(qiáng)表現(xiàn) 膠質(zhì)母細(xì)胞瘤和單發(fā)腦轉(zhuǎn)移瘤均呈不均勻稍長(zhǎng)T1長(zhǎng)T2信號(hào)，囊變、出血多見(jiàn)，周?chē)槊黠@水腫，呈明顯花環(huán)形或斑片狀強(qiáng)化(圖1、2)；淋巴瘤呈稍長(zhǎng)T1不均勻長(zhǎng)T2信號(hào)，其中3例可見(jiàn)囊變，均未見(jiàn)出血，13例周?chē)槊黠@水腫，呈明顯不規(guī)則形或團(tuán)塊狀強(qiáng)化(圖3)。

2.2 DSC-MRI表現(xiàn) 膠質(zhì)母細(xì)胞瘤和單發(fā)腦轉(zhuǎn)移瘤實(shí)質(zhì)區(qū)均呈高灌注表現(xiàn)(圖1、2)；9例淋巴瘤呈低灌注表現(xiàn)(圖3)，3例呈等灌注表現(xiàn)，5例呈稍高灌注表現(xiàn)。

2.3 DSC-MRI參數(shù)結(jié)果分析

2.3.1 瘤體rCBV、瘤周rCBV及瘤體PSR比較 膠質(zhì)母細(xì)胞瘤、單發(fā)腦轉(zhuǎn)移瘤及淋巴瘤的瘤體rCBV值分別為4.27±2.31、4.03±1.73和1.68±0.83，差異具有統(tǒng)計(jì)學(xué)意義(F=11.35，P<0.001)；兩兩比較，膠質(zhì)母細(xì)胞瘤與單發(fā)腦轉(zhuǎn)移瘤rCBV差異無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05)，膠質(zhì)母細(xì)胞瘤和單發(fā)腦轉(zhuǎn)移瘤的瘤體rCBV值均大于淋巴瘤，差異均有統(tǒng)計(jì)學(xué)意義(P均<0.001)。

膠質(zhì)母細(xì)胞瘤、單發(fā)腦轉(zhuǎn)移瘤及淋巴瘤的瘤周rCBV值分別為0.36±0.17、0.10±0.09和0.16±0.12，差異有統(tǒng)計(jì)學(xué)意義(F=14.05，P<0.001)；兩兩比較，單發(fā)腦轉(zhuǎn)移瘤與淋巴瘤差異無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05)，膠質(zhì)母細(xì)胞瘤的瘤周rCBV大于單發(fā)腦轉(zhuǎn)移瘤(P<0.001)，膠質(zhì)母細(xì)胞瘤大于淋巴瘤(P=0.006)，差異均有統(tǒng)計(jì)學(xué)意義。

膠質(zhì)母細(xì)胞瘤、單發(fā)腦轉(zhuǎn)移瘤及淋巴瘤的瘤體PSR值分別為0.80±0.25、0.78±0.58和1.52±0.78，差異有統(tǒng)計(jì)學(xué)意義(F=8.78，P<0.05)；兩兩比較，膠質(zhì)母細(xì)胞瘤與單發(fā)腦轉(zhuǎn)移瘤差異無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05)，膠質(zhì)母細(xì)胞瘤和單發(fā)轉(zhuǎn)移瘤的瘤體PSR值均小于淋巴瘤 (P<0.001、P=0.001)，差異均有統(tǒng)計(jì)學(xué)意義。

2.3.2 不同灌注參數(shù)鑒別診斷淋巴瘤與非淋巴瘤的效能 以瘤體rCBV、瘤周rCBV、瘤體PSR鑒別診斷淋巴瘤與非淋巴瘤(膠質(zhì)母細(xì)胞瘤和單發(fā)腦轉(zhuǎn)移瘤)的AUC分別為0.084(P>0.05)、0.403(P>0.05)、0.875(P<0.05)，見(jiàn)圖4。瘤體PSR=0.9975時(shí)，鑒別診斷淋巴瘤與非淋巴瘤的敏感度為100%，特異度81.3%，約登指數(shù)最大為0.813。

圖1 患者男，50歲，膠質(zhì)母細(xì)胞瘤 A～C.T1WI增強(qiáng)圖像(A)、CBV偽彩圖(B)、灌注原始圖(C)示左額、胼胝體區(qū)不規(guī)則形明顯強(qiáng)化灶，周?chē)槊黠@水腫，實(shí)質(zhì)區(qū)呈明顯高灌注狀態(tài)(紅色區(qū)域?yàn)槟[瘤實(shí)質(zhì)部分，黃色為對(duì)側(cè)正常腦白質(zhì)，綠色為瘤周水腫區(qū)); D.時(shí)間-信號(hào)強(qiáng)度曲線表現(xiàn)為首過(guò)后信號(hào)強(qiáng)度未能達(dá)到基線水平

圖2 患者男，83歲，單發(fā)腦轉(zhuǎn)移瘤(肺腺癌) A～C.T1WI增強(qiáng)圖像(A)、CBV偽彩圖(B)、灌注原始圖(C)示右額頂環(huán)形強(qiáng)化病灶，周?chē)槊黠@水腫，實(shí)質(zhì)區(qū)呈明顯高灌注狀態(tài)( 紅色區(qū)域?yàn)槟[瘤實(shí)質(zhì)部分，黃色為對(duì)側(cè)正常腦白質(zhì)，綠色為瘤周水腫區(qū))； D.時(shí)間-信號(hào)曲線表現(xiàn)為首過(guò)后信號(hào)強(qiáng)度未能達(dá)到基線水平

圖3 患者女，30歲，淋巴瘤 A～C.T1WI增強(qiáng)圖像(A)、CBV偽彩圖(B)、灌注原始圖(C)示右側(cè)側(cè)腦室旁斑片狀明顯強(qiáng)化病灶，周?chē)梢?jiàn)水腫，強(qiáng)化區(qū)呈等低灌注狀態(tài)(紅色區(qū)域?yàn)槟[瘤實(shí)質(zhì)部分，黃色為對(duì)側(cè)正常腦白質(zhì)，綠色為瘤周水腫區(qū))； D.時(shí)間-信號(hào)強(qiáng)度曲線表現(xiàn)為首過(guò)后信號(hào)強(qiáng)度超過(guò)基線水平

圖4 灌注參數(shù)診斷淋巴瘤與非淋巴瘤的ROC曲線

2.3.3 不同灌注參數(shù)鑒別診斷膠質(zhì)母細(xì)胞瘤與轉(zhuǎn)移瘤的效能 瘤體rCBV、瘤周rCBV、瘤體PSR鑒別診斷膠質(zhì)母細(xì)胞瘤與單發(fā)腦轉(zhuǎn)移瘤的AUC分別為0.482(P>0.05)、0.933(P<0.05)、0.592(P<0.05)，見(jiàn)圖5。瘤周rCBV=0.1800時(shí)，鑒別診斷膠質(zhì)母細(xì)胞瘤與單發(fā)腦轉(zhuǎn)移瘤的敏感度為94.1%，特異度86.7%，約登指數(shù)最大為0.808。

圖5 灌注參數(shù)診斷膠質(zhì)母細(xì)胞瘤與單發(fā)轉(zhuǎn)移瘤的ROC曲線

3 討論

腫瘤的侵襲及生長(zhǎng)依賴于血管內(nèi)皮細(xì)胞增生和新生血管程度[1]。研究[2]表明，高級(jí)別星形細(xì)胞瘤如膠質(zhì)母細(xì)胞瘤的惡性程度與腫瘤新生血管生成呈明顯正相關(guān)，微血管結(jié)構(gòu)及新生血管增多可致rCBV值增加。 DSC-MRI是一種快速有效的MR灌注技術(shù)，能提供組織微循環(huán)及血流動(dòng)力學(xué)信息，目前已廣泛應(yīng)用于評(píng)價(jià)顱內(nèi)腫瘤，評(píng)價(jià)參數(shù)多為腦CBV、rCBV、腦血流量(cerebral blood flow, CBF)及平均通過(guò)時(shí)間(mean through time, MTT)、清除率及微血管密度等，其中rCBV應(yīng)用最廣泛。研究[3]認(rèn)為rCBV可反映腫瘤內(nèi)新生血管情況。腦淋巴瘤中，雖然腫瘤呈明顯強(qiáng)化改變，但rCBV值通常較低[3]。另外，微血管密度與rCBV值也明顯相關(guān)，淋巴瘤的微血管密度明顯低于膠質(zhì)母細(xì)胞瘤[4]。轉(zhuǎn)移瘤的新生毛細(xì)血管類似原發(fā)腫瘤，新生血管不存在血腦屏障，故腫瘤呈高灌注[5]，但瘤周水腫區(qū)的毛細(xì)血管結(jié)構(gòu)始終保持正常，無(wú)腫瘤細(xì)胞浸潤(rùn)[6]。研究[7]表明，轉(zhuǎn)移瘤與膠質(zhì)母細(xì)胞瘤的實(shí)質(zhì)區(qū)rCBV值無(wú)明顯差異，但瘤周水腫區(qū)膠質(zhì)母細(xì)胞瘤的rCBV值高于轉(zhuǎn)移瘤。

本研究結(jié)果顯示，膠質(zhì)母細(xì)胞瘤和單發(fā)腦轉(zhuǎn)移瘤的瘤體區(qū)rCBV值明顯大于淋巴瘤，且膠質(zhì)母細(xì)胞瘤瘤周區(qū)rCBV值與單發(fā)腦轉(zhuǎn)移瘤也存在顯著差異，與之前的結(jié)果一致[8-9]。膠質(zhì)母細(xì)胞瘤新生血管豐富，腫瘤細(xì)胞常沿神經(jīng)纖維束或血管間隙向周?chē)?rùn)生長(zhǎng)，故瘤周水腫區(qū)?？砂l(fā)現(xiàn)腫瘤細(xì)胞存在；單發(fā)腦轉(zhuǎn)移瘤保持原發(fā)腫瘤的組織特性，無(wú)正常的血腦屏障，由于自身血管結(jié)構(gòu)特點(diǎn)及多種腫瘤因子誘導(dǎo)血管通透性變大，加上瘤體壓迫鄰近引流靜脈引起的單純血管源性水腫，故水腫區(qū)無(wú)腫瘤細(xì)胞浸潤(rùn)，因此兩者瘤體區(qū)rCBV值均高，而在瘤周區(qū)，膠質(zhì)母細(xì)胞瘤rCBV值明顯高于轉(zhuǎn)移瘤。張曉琦等[10]也證實(shí)，膠質(zhì)母細(xì)胞瘤瘤周區(qū)的微血管通透性明顯高于轉(zhuǎn)移瘤。本研究結(jié)果表明，雖然膠質(zhì)母細(xì)胞瘤和單發(fā)腦轉(zhuǎn)移瘤的瘤體區(qū)rCBV無(wú)統(tǒng)計(jì)學(xué)差異，但瘤周區(qū)二者rCBV存在明顯的差異；ROC曲線示瘤周rCBV值對(duì)于膠質(zhì)母細(xì)胞瘤與單發(fā)腦轉(zhuǎn)移瘤有較高的診斷效能。淋巴瘤組織病理學(xué)特點(diǎn)為瘤細(xì)胞聚集在血管周?chē)市涮谞钆帕衃11]，缺少新生的毛細(xì)血管，故其rCBV值低。在瘤周水腫區(qū)，淋巴瘤與轉(zhuǎn)移瘤一樣缺乏腫瘤組織，無(wú)引起rCBV升高的腫瘤新生血管。本研究淋巴瘤瘤體rCBV與非淋巴瘤(膠質(zhì)母細(xì)胞瘤和單發(fā)轉(zhuǎn)移瘤)存在統(tǒng)計(jì)學(xué)差異，瘤周rCBV與膠質(zhì)母細(xì)胞瘤存在統(tǒng)計(jì)學(xué)差異，但ROC曲線示瘤體rCBV及瘤周rCBV鑒別診斷淋巴瘤與非淋巴瘤的診斷效能不高。因此選擇PSR作為另一個(gè)評(píng)價(jià)指標(biāo)。

灌注成像評(píng)估CBV時(shí)，如果血腦屏障完整，則無(wú)對(duì)比劑滲漏；如果血腦屏障被破壞或發(fā)育不完善，對(duì)比劑于首過(guò)期便快速滲漏出血管外間隙，引起CBV值的低估或高估；而PSR能夠通過(guò)對(duì)比劑到達(dá)前后與基線的對(duì)比反映血腦屏障破壞的情況，是對(duì)CBV參數(shù)的補(bǔ)充。研究[12-13]表明，PSR可反映術(shù)前顱內(nèi)腫瘤的血管滲透性變化。本研究表明，淋巴瘤與非淋巴瘤明顯強(qiáng)化區(qū)內(nèi)血管滲透性明顯不同，淋巴瘤、膠質(zhì)母細(xì)胞瘤、單發(fā)腦轉(zhuǎn)移瘤的PSR分別為1.52±0.78、0.80±0.25、0.78±0.58。對(duì)比劑首過(guò)后，淋巴瘤的信號(hào)強(qiáng)度增加超過(guò)基線水平，而膠質(zhì)母細(xì)胞瘤和單發(fā)腦轉(zhuǎn)移瘤多不能恢復(fù)至基線，與Xing等[8]研究一致。團(tuán)注對(duì)比劑后，會(huì)引起局部磁場(chǎng)不均勻，T1、T2均縮短，首過(guò)期間對(duì)比劑在血管內(nèi)，T2縮短效應(yīng)大于T1縮短效應(yīng)，出現(xiàn)負(fù)性增強(qiáng)；首過(guò)期間或首過(guò)后，對(duì)比劑滲漏到組織間隙，T1縮短效應(yīng)增大，超過(guò)T2效應(yīng)時(shí)，信號(hào)強(qiáng)度會(huì)增加甚至超過(guò)基線，PSR增高；提示淋巴瘤比膠質(zhì)母細(xì)胞瘤和單發(fā)腦轉(zhuǎn)移瘤對(duì)比劑滲漏到組織間隙更明顯。本研究結(jié)果顯示，膠質(zhì)母細(xì)胞瘤與單發(fā)腦轉(zhuǎn)移瘤PSR值差異無(wú)統(tǒng)計(jì)學(xué)意義，膠質(zhì)母細(xì)胞瘤和轉(zhuǎn)移瘤的瘤體PSR值均小于淋巴瘤，瘤體PSR鑒別淋巴瘤與非淋巴瘤具有較高的效能，與陳杰云等[9]的研究結(jié)果不同，這可能與病例選擇、處理方法及成像技術(shù)等有關(guān)。

總之，rCBV值和PSR對(duì)3種腫瘤的鑒別有重要意義，前者反映腫瘤血管化程度，后者反映血腦屏障破壞情況，二者聯(lián)合應(yīng)用更有助于3種腫瘤的鑒別。

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[2] 姜新雅,仇斌,王維.星形細(xì)胞瘤相對(duì)腦血容量與腫瘤血管生成的相關(guān)性研究.中國(guó)醫(yī)學(xué)影像技術(shù),2006,22(3):401-404.

[3] 張仙海,高明勇,周新韓,等.MR灌注加權(quán)成像和磁敏感加權(quán)成像評(píng)價(jià)膠質(zhì)瘤.中國(guó)醫(yī)學(xué)影像技術(shù),2013,29(12):1937-1940.

[4] Liao W, Liu Y, Wang X, et al. Differentiation of primary central nervous system lymphoma and high-grade glioma with dynamic susceptibility contrast-enhanced perfusion magnetic resonance imaging. Acta Radiol, 2009,50(2):217-225.

[5] Law M, Cha S, Knopp EA, et a1.High-grade gliomas and soliaty metastases: Differentiation by using perfusion and proton spectroscopic MR imaging. Radiology, 2002,222(3):715-721.

[6] 張皓,沈天真,陳星榮,等.MR灌注成像在鑒別單發(fā)腦轉(zhuǎn)移瘤與高級(jí)別膠質(zhì)瘤中的價(jià)值.中華放射學(xué)雜志,2006,40(4):393-396.

[7] 楊向麗,張輝,梁麗,等.動(dòng)態(tài)磁敏感對(duì)比增強(qiáng)灌注技術(shù)在腦腫瘤鑒別診斷中的價(jià)值.中西醫(yī)結(jié)合心腦血管病雜志,2011,9(3):319-321.

[8] Xing Z, You RX, Li J, et al. Differentiation of primary central nervous system lymphomas from high-grade gliomas by rCBV and percentage of signal intensity recovery derived from dynamic susceptibility-weighted contrast-enhanced perfusion MR imaging. Clin Neuroradiol,2014,24(4):329-336.

[9] 陳杰云,林曉瑩,陳向榮,等.MR灌注加權(quán)成像鑒別診斷單發(fā)腦轉(zhuǎn)移瘤與高級(jí)別膠質(zhì)瘤.中國(guó)醫(yī)學(xué)影像技術(shù),2015,31(2):215-218.

[10] 張曉琦,李永麗,竇社偉,等.動(dòng)態(tài)對(duì)比增強(qiáng)MRI在膠質(zhì)母細(xì)胞瘤與腦轉(zhuǎn)移瘤鑒別診斷中的應(yīng)用.中華放射學(xué)雜志,2015,49(6):410-413.

[11] Deckert M, Engert A, Bruck W, et al. Modern concepts in the biology,diagnosis,differential diagnosis and treatment of primary central nervous system lymphoma. Leukemia, 2011,25(12):1797-1807.

[12] Lupo JM, Cha S, Chang SM, et al. Dynamic susceptibility-weighted perfusion imaging of high-grade gliomas: Characterization of spatial heterogeneity. AJNR Am J Neuroradiol, 2005,26(6):1446-1454.

[13] Cha S, Lupo JM, Chen MH, Lamborn KR, et al. Differentiation of glioblastoma multiforme and single brain metastasis by peak height and percentage of signal intensity recovery derived from dynamic susceptibility-weighted contrast-enhanced perfusion MR imaging. AJNR Am J Neuroradiol, 2007,28(8):1078-1084.

天津市衛(wèi)生局重點(diǎn)攻關(guān)基金(12KG115)、天津市科委科技支撐項(xiàng)目重大抗癌專項(xiàng)基金(12ZCDZSY17700)。

盧昊(1986—)，男，天津人，在讀碩士，技師。研究方向：神經(jīng)影像學(xué)。E-mail: luhaomr23@sina.com

韓彤，天津市環(huán)湖醫(yī)院磁共振室，300350。E-mail: mrbold@163.com

2017-01-03

2017-06-05

DSC-MRI鑒別診斷膠質(zhì)母細(xì)胞瘤、單發(fā)腦轉(zhuǎn)移瘤及腦淋巴瘤

盧 昊1,2，馮全志1，程乾勝2，丁 巖2，李代斌2，李雨格2，韓碧輝2，韓 彤2*

(1.天津醫(yī)科大學(xué)研究生院，天津 300060；2.天津市環(huán)湖醫(yī)院磁共振室，天津 300350)

目的 探討動(dòng)態(tài)磁敏感對(duì)比增強(qiáng)磁共振成像(DSC-MRI)鑒別診斷膠質(zhì)母細(xì)胞瘤、單發(fā)腦轉(zhuǎn)移瘤及腦淋巴瘤的價(jià)值。方法 回顧性分析經(jīng)活檢或術(shù)后病理證實(shí)的膠質(zhì)母細(xì)胞瘤患者17例、單發(fā)腦轉(zhuǎn)移瘤患者15例、淋巴瘤患者17例。患者術(shù)前均接受MRI常規(guī)平掃、增強(qiáng)及DSC-MRI掃描，獲得腦血容量(CBV)偽彩圖及時(shí)間-信號(hào)強(qiáng)度曲線，分別測(cè)量瘤體、瘤周水腫區(qū)及對(duì)側(cè)正常白質(zhì)區(qū)的CBV值，計(jì)算相對(duì)腦血容量(rCBV)值和瘤體的信號(hào)強(qiáng)度恢復(fù)百分比(PSR)。應(yīng)用ROC曲線分析各指標(biāo)對(duì)3種腫瘤的診斷效能。結(jié)果 膠質(zhì)母細(xì)胞瘤、單發(fā)腦轉(zhuǎn)移瘤及腦淋巴瘤均表現(xiàn)為腫瘤實(shí)性區(qū)域明顯強(qiáng)化伴瘤周水腫。瘤體rCBV除膠質(zhì)母細(xì)胞瘤與單發(fā)腦轉(zhuǎn)移瘤無(wú)差異外，余兩兩比較差異均有統(tǒng)計(jì)學(xué)意義(P均<0.05)；瘤周rCBV除單發(fā)腦轉(zhuǎn)移瘤與淋巴瘤無(wú)差異外，余兩兩比較差異均有統(tǒng)計(jì)學(xué)意義(P均<0.05)；瘤體PSR值除膠質(zhì)母細(xì)胞瘤與單發(fā)腦轉(zhuǎn)移瘤無(wú)差異外，余兩兩比較差異均有統(tǒng)計(jì)學(xué)意義(P均<0.05)。ROC曲線示瘤體PSR為鑒別淋巴瘤及非淋巴瘤的最佳指標(biāo)，敏感度、特異度分別為100%和81.3%；瘤周rCBV為鑒別膠質(zhì)母細(xì)胞瘤及單發(fā)腦轉(zhuǎn)移瘤的最佳指標(biāo)，敏感度、特異度分別為94.1%和86.7%。結(jié)論 rCBV和PSR結(jié)合可提高鑒別診斷3種腦腫瘤的效能。

膠質(zhì)母細(xì)胞瘤；單發(fā)腦轉(zhuǎn)移瘤；淋巴瘤；磁共振成像

R739.41; R445.2

A

1003-3289(2017)08-1185-05

10.13929/j.1003-3289.201701139