MR常规序列及弥散加权成像在脑膜瘤良恶性鉴别和亚型区分的价值探讨

发布时间：2018-03-18 04:13

  本文选题：脑膜瘤　切入点：常规MR成像　出处：《川北医学院》2014年硕士论文　论文类型：学位论文

【摘要】：目的：对脑膜瘤术前MRI常规扫描序列的影像特征进行分析，与病理结果对照，探讨常规磁共振扫描区分良、恶性脑膜瘤和常见亚型脑膜瘤的可行性。 材料与方法：回顾性分析139例（其中121例进行了亚型的区分）已被病理证实为脑膜瘤的患者术前头颅MRI影像，观察病灶的位置、肿瘤大小、形态、瘤周水肿程度和肿瘤在T1WI、T2WI、T2Flair等MRI常规序列上的信号强度。比较上述影像表现在良恶性脑膜瘤之间及不同亚型脑膜瘤之间的差异。同时对患者年龄、性别等一般因素进行统计分析。 结果：本组139例脑膜瘤中WHOⅠ级130例、WHOⅡ、Ⅲ分别为6例和3例，良性脑膜瘤中纤维型、上皮型、混合型和血管瘤型、微囊型是主要亚型(分别为46例,35例,17例和7例，3例)。 1、年龄、性别:发病年龄在良、恶性脑膜瘤组间及不同亚型间无统计学差异；各主要亚型脑膜瘤在不同性别比例中有差异，纤维型脑膜瘤好发于女性，上皮型脑膜瘤在男性占较大比例(P=0.01)。 2、肿瘤大小、形态发生位置:肿瘤平均直径在良、恶性脑膜瘤组间及不同亚型间比较，差异均无统计学意义。肿瘤形态在良、恶性脑膜瘤组间差异有统计学意义（p=0.043），恶性脑膜瘤多表现为明显分叶状；主要亚型中纤维型脑膜瘤以形态规则和浅分叶为主，非典型、血管瘤型多表现为分叶状（P＜0.05）。130例良性脑膜瘤，发生于颅底面26例，9例恶性脑膜瘤发生于颅底面6例，差异有统计学意义(p=0.005)。纤维型VS上皮型（p=0.001），纤维型VS非典型（p=0.005）,亚型的位置分布差异有统计学意义。 3、瘤周水肿：良、恶性脑膜瘤组间瘤周水肿程度比较无统计学差异（p=0.291；主要亚型瘤周水肿程度为上皮型＞非典型＞血管瘤型＞微囊型＞混合型＞纤维型，其中上皮型VS纤维型(P＜0.01)、上皮型VS混合型(P=0.002)，非典型VS纤维型(P=0.023)，差异有统计学意义。脑膜瘤由小到大水肿出现率分别为37.73%、78.43%、88.57%，肿瘤大小与水肿程度呈正相关性（r=0.312**、 P＜0.01）. 4、MR常规序列肿瘤信号强度：良、恶性两组进行比较，肿瘤信号强度在各序列上无统计学意义（p＞0.05）。主要亚型中微囊型、血管瘤型T1WI序列信号低于其它亚型、T2WI序列信号高于其它亚型，差异均有统计学意义（p＜0.05）。其余亚型T1WI信号差异无统计学意义。T2Flair序列上述亚型信号差别均无统计学意义。 结论：常规MR扫描序列存在部分特征性影像表现，对于脑膜瘤良恶性以及亚型区分有一定作用，能对部分亚型的生物学行为予以提示。 目的：探讨弥散加权（DWI）图像信号和表观弥散系数(ADC)能否在术前区分出不同病理级别或病理亚型的脑膜瘤，为临床手术方式和治疗方案的选择提供帮助。 材料与方法：对94例已被病理证实为脑膜瘤患者的术前头颅MRI图像进行回顾性实验研究，观察DWI图像肿瘤信号,以脑皮质为参照记为低信号、等信号及高信号；在ADC图像上分别测量肿瘤实质平均ADC值、最小ADC值、最大ADC值。将DWI信号、ADC测量结果分别与病理分级、分型对比分析。 结果： 1、DWI信号强度在良、恶性脑膜瘤组间无统计学差异（P=0.379）。微囊型脑膜瘤DWI信号以高、明显高信号为主，，但与其它亚型比较无统计学差异（P=0.201）。 2、良、恶性脑膜瘤平均ADC值为（97.34±18.53VS89.83±7.79）×10-5mm2/s、最小ADC值(92.61±16.95VS85.42±7.11)×10-5mm2/s、最大ADC值(103.49±20.96VS94.52±8.14)×10-5mm2/s，各组ADC值均为良性组高于恶性组，但组间差异无统计学意义（P＞0.05）。主要亚型中血管瘤型平均ADC值（129.00±20.90）×10-5mm2/s，最小ADC值（122.60±20.51）×10-5mm2/s，最大ADC值（136.71±22.16）×10-5mm2/s,各组ADC值均高于其它亚型，差异有统计学意义（P＜0.05）。 结论：本次实验结果显示，磁共振弥散加权成像（DWI）和ADC值在良、恶性脑膜瘤组间无统计学差异，但DWI和ADC可以对部分亚型进行区分，对脑膜瘤亚型的诊断有一定的价值。
[Abstract]:Objective: to analyze the imaging features of preoperative MRI routine scanning sequence and compare with pathological findings, and explore the feasibility of conventional magnetic resonance imaging in differentiating benign from malignant meningioma and common submeningioma.
Materials and methods: a retrospective analysis of 139 cases (including 121 cases of sub type) have been pathologically confirmed meningiomas before surgery in patients with cranial MRI images, observed the location of the lesion, tumor size, shape, and degree of peritumoral edema and tumor in T1WI, T2WI, T2Flair and MRI signal intensity of conventional sequence. The difference in the image. A comparison between benign and malignant meningiomas and different subtypes of meningioma. While patients with age, gender and other general factors were analyzed.
Results: in 139 cases of meningiomas, there were 130 cases of WHO grade I, 6 cases of WHO II and 3 cases of benign meningiomas. There were fibrous, epithelial, mixed and hemangioma types in the benign meningiomas. The subtypes of microcapsules were mainly subtypes (46 cases, 35 cases, 17 cases and 7 cases, 3 cases), respectively.
1, age and gender: there was no significant difference in age of onset between benign and malignant meningioma group and between different subtypes. Meningiomas of all major subtypes were different in different sex ratios. Fibrous meningiomas were frequent in females, and epithelial meningiomas were larger in males (P=0.01).
2, tumor size, morphogenetic position: the mean diameter of the tumor in benign and malignant meningiomas, comparison between groups and different subtypes, there were no significant differences in tumor morphology. In benign and malignant meningioma was statistically significant difference between groups (p=0.043), malignant meningioma showed obvious lobulated; major subtypes in fiber type with meningioma morphological rules and superficial lobulation, atypical hemangioma type showed lobulated (P < 0.05).130 cases of benign meningiomas, 26 cases occurred on the surface of skull base, 9 cases of malignant meningiomas in 6 cases of skull base surface, the difference was statistically significant (p=0.005). Fiber type VS epithelial (p=0.001) fiber type, atypical VS (p=0.005), was statistically significant difference position distribution of subtypes.
Zhou Shuizhong: good, 3 tumors had no significant difference between the groups of malignant meningioma peritumoral edema (p=0.291; main subtypes of peritumoral edema in epithelial type, atypical angiomatous type > > > > were mixed type fiber type, the epithelial type VS fiber type (P < 0.01), skin type VS mixed type (P=0.002), atypical type VS fiber (P=0.023), the difference was statistically significant. The rate was 37.73%, 78.43% from 88.57% meningioma appeared edema, edema, tumor size and degree of positive correlation (r=0.312**, P < 0.01).
4, conventional MR imaging signal intensity of lesions were compared between the two groups: benign, malignant tumor, signal intensity was not statistically significant in each sequence (P > 0.05). The main microcystic subtypes, hemangioma type T1WI sequence signal is lower than that of other subtypes, the T2WI sequence signal is higher than other subtypes, the differences were statistically significant (P < 0.05). The other subtypes of T1WI signal.T2Flair there were no significant differences between the subtypes of signal sequence differences were not statistically significant.
Conclusion: there are some characteristic imaging findings in conventional MR scanning sequences, which is helpful for differentiating benign and malignant meningiomas and subtypes. It can prompt some biological behaviors of subtypes.
Objective: To investigate whether diffusion-weighted (DWI) image and apparent diffusion coefficient (ADC) can differentiate the meningiomas with different pathological grades or pathological subtypes before operation, so as to provide help for the selection of surgical procedures and treatment options.
Materials and methods: 94 cases had been pathologically confirmed meningiomas. The preoperative cranial MRI images were retrospectively study, observation of tumor DWI image signal in cerebral cortex as the reference signal recorded as low signal and high signal in ADC images were measured; the average ADC value of tumor parenchyma, the minimum ADC value. The maximum value of ADC. DWI signal, ADC measurement results were compared with the pathological classification, analysis of contrast.
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