磁共振扩散加权成像和灌注加权成像在非典型脑炎与低级别胶质瘤鉴别诊断中的价值

doi:10.3969/j.issn.1009-976X.2021.04.013

摘要/Abstract

摘要： 目的探讨磁共振扩散加权成像（DWI）和磁共振灌注加权成像（PWI）在非典型脑炎与低级别胶质瘤鉴别诊断中的价值。方法回顾性分析2016年5月至2020年12月期间于我院就诊的14例非典型脑炎患者和31例低级别胶质瘤患者的临床及影像学资料,所有患者经影像学检查、生化检查及手术病理检查证实。所有患者均接受DWI和PWI检查,对病变实性成分和对侧镜像正常脑白质区进行测量,计算得出相对最小表观扩散系数值（rADCmin）和相对最大脑血容量值（rCBVmax）,比较两组间rADCmin和rCBVmax的差异性。结果非典型脑炎组的rADCmin高于低级别胶质瘤组、rCBVmax低于低级别胶质瘤组（P<0.05）。rADCmin鉴别非典型脑炎和低级别胶质瘤的最佳阈值是1.14,敏感性、特异性和AUC分别为96.77%、90.00%和0.903;rCBVmax鉴别非典型脑炎和低级别胶质瘤的最佳阈值是2.26,敏感性、特异性和AUC分别为64.52%、100%和0.726。结论 DWI和PWI检查在非典型脑炎与低级别胶质瘤的鉴别诊断中具有重要的价值,DWI的诊断效能优于PWI。

关键词: 脑炎, 低级别胶质瘤, 磁共振成像, 扩散加权成像, 灌注加权成像

Abstract: Objective To explore the value of diffusion-weighted imaging （DWI） and perfusion weighted imaging （PWI） in the differential diagnosis of atypical encephalitis and low-grade glioma. Methods The clinical and imaging data of 14 patients with atypical encephalitis and 31 patients with low-grade glioma in our hospital from May 2016 to December 2020 were retrospectively analyzed. Diffusion weighted imaging （DWI） and perfusion weighted imaging （PWI） were performed in all patients. Then the solid components of the lesions and the contralateral normal white matter were measured. The relative minimum apparent diffusion coefficient （rADCmin） and relative maximum cerebral blood volume （rCBVmax） were calculated. The differences of rADCmin and rCBVmax between the two groups were analyzed and compared. Results The rADCmin of atypical encephalitis group was higher than that of low-grade glioma group, and rCBVmax was lower than that of low grade glioma group（P<0.05）. The best threshold of rADCmin for differentiating atypical encephalitis from low grade glioma was 1.14, the sensitivity, specificity and area under the curve （AUC） were 96.77%, 90.00% and 0.903 respectively. The best threshold of rCBVmax for differentiating atypical encephalitis from low grade glioma was 2.26, the sensitivity, specificity and AUC were 64.52%, 100% and 0.726 respectively. Conclusion DWI and PWI are of great value in the differential diagnosis of atypical encephalitis and low-grade gliomas. DWI is superior to PWI in the diagnosis of atypical encephalitis.

Key words: encephalitis, low grade glioma, MRI, diffusion weighted imaging, perfusion weighted imaging

中图分类号:

R445.2

黄欣瑶, 杨谢峰, 苏妍, 邢振. 磁共振扩散加权成像和灌注加权成像在非典型脑炎与低级别胶质瘤鉴别诊断中的价值[J]. 岭南现代临床外科, 2021, 21(04): 437-440.

HUANG Xin-yao, YANG Xie-feng, SU Yan, XING Zhen. The value of diffusion-weighted imaging and perfusion weighted imaging in the differential diagnosis of encephalitis and low grade glioma[J]. Lingnan Modern Clinics In Surgery, 2021, 21(04): 437-440.

参考文献

[1] Han Y, Yang Y, Shi ZS, et al.Distinguishing brain inflammation from grade II glioma in population without contrast enhance-
ment:a radiomics analysis based on conventional MRI[J].Eur J Radiol,2021,134:109467.
[2] Lapointe S,Perry A,Butowski NA.Butowski. Primary brain tu-mours in adults[J]. Lancet,2018,392(10145):432-446.
[3] 郑冲霄,李传亭. 磁共振成像技术在病毒性脑炎诊断中的应用进展[J]. 医学影像学杂志,2010,20(2):278-280.
[4] 尹子铭,石建军,续秋艳,等. DWI联合MRS对病毒性脑炎和脑低级别胶质瘤的诊断价值[J]. 中国CT 和MRI 杂志,2018,16(1):19-22.
[5] 吉婷婷,余成新. 磁共振灌注加权成像在中枢神经系统中的应用[J]. 临床神经病学杂志,2015,28(1):77-79.
[6] 李永,谢明伟,石广滋,等. 磁共振弥散加权成像在胆囊良、恶性病变鉴别诊断中的价值[J]. 岭南现代临床外科,2019,19(5):541-543.
[7] Steiner I,Budka H,Chaudhuri A,et al.Viral encephalitis:a review of diagnostic methods and guidelines for management
[J]. Eur J Neurol,2005,12(5):331-43.
[8] 杨喜彪,许照敏,张洪静,等. 质子磁共振波谱对脑炎与脑炎样胶质瘤鉴别诊断的价值[J]. 临床放射学杂志,2016,35(12):1796-1800.
[9] 戴景儒,戴世鹏,庞军. DWI 鉴别诊断病毒性脑炎与急性播散性脑脊髓炎[J]. 中国医学影像技术,2008,24(10):1561-1564.
[10] 陆梦如,曾丽,蒋小英,等. 氢质子磁共振波谱对脑低级别胶质瘤与病毒性脑炎的鉴别诊断价值[J]. 临床神经病学杂志,2015,28(5):330-333.
[11] 邢振,曹代荣,刘颖,等. MRI 灌注加权成像的信号强度-时间曲线在脑胶质瘤分级诊断中的价值[J]. 中华神经外科杂志,2013,29(11):1125-1128.
[12] Nagesh C,Kumar S,Menon R,et al.The Imaging of Localiza-tion Related Symptomatic Epilepsies:The Value of Arterial
Spin Labelling Based Magnetic Resonance Perfusion[J]. Kore-an J Radiol,2018,19(5):965-977.
[13] 邢振,曾峥,佘德君,等. 3.0TMR多模态功能成像在胶质瘤术后复发与放射性坏死鉴别诊断中的价值[J]. 临床放射学杂志,2016,35(9):1309-1313.

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