摘要
目的 探讨MRI特征术前鉴别诊断幕上多形性黄色星形细胞瘤(PXA)和毛细胞型星形细胞瘤(PA)的价值.方法 回顾性纳入经病理确诊的幕上PXA患者29例和幕上PA患者26例,比较分析两组患者的年龄、性别、肿瘤部位、大小、影像学分型、强化程度、瘤周水肿以及是否有邻近软脑膜的强化,对MRI特征进行Logistic回归分析,计算单因素分析中P＜0.05的MRI征象及不同组合对于幕上PXA和PA的鉴别诊断效能,并采用受试者工作特征(ROC)曲线分析诊断效能.结果 年龄、部位、大小和瘤周水肿程度在幕上PXA和PA间的差异有统计学意义(P均＜0.05).多因素Logistic回归表明,肿瘤部位、大小和瘤周水肿程度对鉴别幕上PXA和PA均具有较高的诊断价值,肿瘤大小的敏感度最高(88.5％),肿瘤部位联合瘤周水肿的特异度最高(89.7％),部位联合大小和瘤周水肿的鉴别诊断效能最高[曲线下面积(AUC)为0.858,敏感度和特异度分别为73.1％、86.2％].结论 幕上PXA和PA的好发部位、肿瘤大小及瘤周水肿程度有差异,术前MRI检查有助于二者的鉴别诊断.
Abstract
Objective To investigate the value of MRI features in the preoperative differential diagnosis between suprat-entorial pleomorphic xanthoastrocytoma(PXA)and pilocytic astrocytoma(PA).Methods Twenty-nine pathologically-confirmed PXA patients and twenty-six PA patients were retrospectively recruited.Clinical and MR imaging data,including age,gender,tumor site,size,predominant radiologic pattern,contrast enhancement pattern,peritumoral edema and presence of adjacent leptomeningeal involvement,were collected and assessed.Logistic regression analysis was performed on MRI characteristics,and the diagnostic efficacy of MRI signs with P＜0.05 in univariate analysis and different combinations in differentiating PXAs from PAs was further calculated.The receiver operating characteristic curve was used to evaluate the di-agnostic efficiency and calculate the area under the curve(AUC).Results There were statistically significant differences in age,location,size and peritumoral edema between the PXA group and the PA group(all P＜0.05).Multivariate logistic regression showed that tumor site,size,and peritumoral edema were all highly valuable in differentiating them.Tumor size showed the highest sensitivity(88.5％),while the combination of location and peritumoral edema exhibited the highest spe-cificity(89.7％).The combination of location,size,and peritumoral edema demonstrated the highest differential diagnostic efficacy,with an area under the curve(AUC)of 0.858,sensitivity of 73.1％,and specificity of 86.2％.Conclusion There are differences in tumor site,size,and degree of peritumoral edema between PXA and PA,therefore preoperative MRI may assist in the differential diagnosis.
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