多序列MRI鉴别诊断高级别脑胶质瘤与单发脑转移瘤的价值-东南大学学报医学版

多序列MRI鉴别诊断高级别脑胶质瘤与单发脑转移瘤的价值

单位：1. 北大荒集团总医院影像科, 黑龙江哈尔滨 150006;
2. 哈尔滨医科大学附属第一医院超声科, 黑龙江哈尔滨 150000

分类号：R445;R739.41

出版年·卷·期（页码）：2025·44·第三期（387-395）

摘要：

目的: 分析多序列MRI对高级别脑胶质瘤(HGG)与单发脑转移瘤(SBM)的鉴别诊断价值。方法: 回顾性分析在院诊治的HGG和SBM患者60例,其中HGG患者34例纳入为HGG组,SBM患者26例纳入为SBM组,均开展常规MRI扫描,包括T₂WI、T₁WI、FLAIR、T₁增强扫描,并开展扩散加权成像(DWI)扫描,比较常规MRI扫描和DWI扫描的信号检测情况以及表观扩散系数(ADC)和相对表观扩散系数(rADC),并采用ROC曲线分析其对HGG和SBM的鉴别诊断价值。结果: HGG组T₁WI、T₂WI信号强度与SBM组相比差异无统计学意义(P>0.05),HGG组T₁WI增强、T₂WI-FLAIR平扫、T₂WI-FLAIR增强的高信号占比(73.58% vs 11.54%、70.59% vs 7.69%、91.18% vs 15.38%)与SBM组相比更高(χ²值分别为22.748、23.735、34.821,P<0.05)。HGG、SBM组的瘤周水肿区均呈现ADC高信号、DWI低信号,瘤体实质区均呈现DWI高信号,HGG组瘤体实质区ADC信号强度与SBM组相比差异无统计学意义(P>0.05)。HGG组瘤体实质区、对侧正常区的ADC、rADC与SBM组相比差异无统计学意义(P>0.05),HGG组瘤周水肿区的ADC、rADC与SBM组相比更低(t值分别为5.332、6.663,P<0.05)。ROC曲线分析得出瘤周水肿区ADC、rADC及模型鉴别诊断HGG、SBM的AUC分别为0.829、0.867、0.983;模型鉴别诊断HGG和SBM的AUC高于瘤周水肿区ADC、rADC单独鉴别诊断(P<0.05)。结论: 基于T₁WI增强、T₂WI-FLAIR平扫、T₂WI-FLAIR增强及瘤周水肿区的ADC、rADC构建的模型对HGG和SBM具有一定的辅助鉴别诊断价值。

Objective: To analyze the differential diagnostic value of multi sequence MRI in high-grade gliomas(HGG) and solitary brain metastases(SBM). Methods: A retrospective analysis was conducted on 60 patients with HGG and SBM treated in our hospital. Among them, 34 patients with HGG were included in the HGG group, and 26 patients with SBM were included in the SBM group. All patients underwent routine MRI scans, including T₂WI, T₁WI, FLAIR, T₁ enhanced scans, and diffusion-weighted imaging(DWI) scans. The signal detection of routine MRI scans and DWI scans, as well as the apparent diffusion coefficient(ADC) and relative apparent diffusion coefficient(rADC), were analyzed, and the ROC curve was used to evaluate their differential diagnostic value for HGG and SBM. Results: There was no statistically significant difference in the signal intensity of T₁WI and T₂WI between the HGG group and the SBM group(P>0.05). The high signal intensity of T₁WI enhancement, T₂WI-FLAIR plain scan, and T₂WI-FLAIR enhancement in the HGG group(73.58% vs 11.54%, 70.59% vs 7.69%, 91.18% vs 15.38%) was higher than that in the SBM group(χ²: 22.748, 23.735, 34.821, P<0.05). The peritumoral edema areas in both HGG and SBM groups showed high ADC signal and low DWI signal, while the tumor parenchyma areas showed high DWI signal. The ADC signal intensity in the tumor parenchyma area of HGG group was not statistically significant compared to SBM group(P>0.05). There were no statistically significant differences on ADC, rADC of the tumor parenchyma areas and the normal area of the opposite side of the tumor between HGG group and SBM group(P>0.05), while the ADC, rADC in the peritumoral edema area of the HGG group were lower than those in the SBM group(t: 5.332, 6.663, P<0.05). The ROC curve analysis showed that the AUC of ADC, rADC, and the model for differential diagnosis of HGG and SBM in the peritumoral edema area were 0.829, 0.867, and 0.983, respectively. The AUC of the model for differential diagnosis of HGG and SBM was higher than that of the individual differential diagnosis of ADC and rADC in the peritumoral edema area(P<0.05). Conclusion: T₁WI enhancement, T₂WI-FLAIR plain scan, T₂WI-FLAIR enhancement, and ADC and rADC in the peritumoral edema area can differentiate HGG and SBM. The model constructed based on this has some assistance differential diagnostic value for HGG and SBM.

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