摘要
目的:探讨MR扩散加权成像(DWI)和3D肝脏容积快速采集(LAVA)序列动态对比增强(DCE)MRI扫描对颅内呈环形强化的胶质母细胞瘤(GBM)和感染性病变的鉴别诊断价值.方法:回顾性搜集2015年9月-2020年9月在本院经病理证实的23例脑GBM和17例颅内感染性病变(脑脓肿11例,结核瘤6例)患者的临床和MRI资料.所有患者在术前2周内行3.0T颅脑MRI扫描,扫描序列包括常规序列、对比增强T1WI、DWI和LAVA序列DCE-MRI扫描.分别使用Firevoxel软件和GE Omni-Kinetics软件在每例患者的表观扩散系数(ADC)图和DCE图像中选取病灶最大层面于病灶内环形强化区域手动勾画ROI,测量并比较两组病变的ADC第一四分位数(ADC-P25)、容积转移常数(Ktrans)、血管外细胞外体积分数(Ve)、增强曲线下初始面积(IAUGC)、速率常数(Kep)、血浆容积分数(Vp)、达峰时间(TTP)和最大斜率(SMAX)测量值的差异.Ktrans、Vp和IAUGC的组间比较采用独立样本t检验,ADC-P25、Kep、Vp、TTP和SMAX的组间比较采用Mann-Whitney U检验.对组间差异有统计学意义的参数,绘制其受试者工作曲线(ROC),评估单个参数和多参数联合后对GBM和感染性病变的鉴别诊断效能.将AUC＜0.7、0.7～0.9和＞0.9分别定义为具有低、中和高度诊断效能.结果:GBM的Ktrans、IAUGC和SMAX值均显著高于感染性病变,差异均有统计学意义(P=0.004、0.045、0.011),而ADC-P25显著低于感染性病变(P=0.042).Ktrans、ADC-P25和SMAX值对两种病变均达到了中度以上的鉴别诊断效能,单一参数诊断效能最佳的是Ktrans,联合ADC-P25、Ktrans和SMAX三个参数的诊断效能最佳,其ROC曲线下面积、敏感度和特异度分别为0.967、0.900和1.000.结论:DWI和DCE-MRI定量及半定量参数对呈环形强化的GBM和感染性病变均具有一定的鉴别能力,两类参数联合可显著提高鉴别诊断效能.
Abstract
Objective:This study was aimed to evaluate the diagnostic performance of diffusion-weighted imaging(DWI)and dynamic contrast-enhanced(DCE)-MRI to identify ring-shape enhanced GBM from ring-enhanced infectious lesions.Methods:Twenty-three patients with brain GBM and se-venteen patients with intracranial infectious lesions(eleven brain abscess and six tuberculomas)con-firmed by pathology were retrospectively analyzed from September 2015 to September 2020.All pa-tients underwent brain MRI examination at a 3.0T scanner within 2 weeks before surgery,and the se-quences included T1WI,T2WI,contrast-enhanced T1WI,DWI and 3D liver acquisition with volume ac-celeration(LAVA)DCE-MRI.The region of interest(RGI)of tumor and infectious lesion was ma-nually delineated on the largest layer of apparent diffusion coefficient(ADC)and DCE images using Firevoxel software and GE Omni-Kinetics software.Then,to compare the differences of ADC first quartile(ADC-P25),volume transfer constant(Ktrans),volume of the extracellular extracellular space(Ve),initial area under the gadolinium curve(IAUGC),back flux constant(Kep),plasma volume frac-tion(Vp),time to peak(TTP)and maximum rise slope(SMAx)between the two groups.Ktrans,IAUGC and Vp were compared between the two groups with use of the independent sample t-test,while ADC-P25,Kep,Ve,TTP and SMAX were compared between the two groups with use of the Mann-Whitney U-test.In addition,the area under the receiver operating characteristic(ROC)curve(AUC)was acquired to assess the differentiation diagnostic efficacy of the parameters with statistical difference.AUC＜0.7,0.7～0.9 and＞0.9 was named as low,median and high diagnostic efficacy.Results:Ktrans,IAUGC and SMAX of the GBM group were significantly higher than those of the infectious lesions group,P-values respectively were 0.004,0.045 and 0.011,respectively;while ADC-P25 of the GBM group was signifi-cantly lower than that of the infectious lesions group(P=0.042).For the ROC analysis,both DWI and DCE-MRI parameters had good diagnostic performance for discriminating GBM from infectious le-sions,the best diagnostic performance of single parameter was Ktrans,combined ADC-P25,Ktrans and SMAX had the best diagnostic performance,and its AUC,sensitivity and specificity were 0.967,0.900 and 1.000,respectively.Conclusion:Both DWI and DCE-MRI have ability to identify GBM from infec-tious lesions to a certain extent,and their combination can significantly improve the diagnosis efficiency.
基金项目
国家自然科学基金(81971594)
陕西省自然科学基础研究计划重点项目(2023-JC-ZD-58)
维普
万方数据