原发性中枢神经系统淋巴瘤的MR征象分析及ADC值在鉴别诊断中的价值
发布时间：2018-09-11 20:57
【摘要】：第一部分原发性中枢神经系统淋巴瘤的MR征象分析及3D增强多平面重建的价值研究目的：探讨免疫功能正常的原发性中枢神经系统淋巴瘤(primary central nervous system lymphoma, PCNSL)常规MRI征象及3D多平面重建增强在诊断中的价值。方法：回顾性分析93例经病理或穿刺证实为PCNSL的MRI特征,其中41例常规增强扫描,40例行3D多平面重建增强扫描,12例两种均有检查,并比较常规MR增强与3D多平面重建增强后对于PCNSL典型征象的检出率。结果： 93例患者均为B细胞性非霍奇金淋巴瘤。单发49例(52.6%),多发44例(47.3%)；共检出167个病灶。病灶好发于幕上(85%)142个病灶位于幕上,25个位于幕下,主要分布于深部脑白质等近中线部位及靠近脑膜表面。MRI平扫病灶T1WI多呈等或稍低信号,T2WI多呈等或稍高信号。159个病灶在DWI上均呈高或稍高信号。增强后163个病灶实质成分均呈团块状、结节状明显强化,4个病灶无强化。8个出现“蝴蝶征”。43个病灶呈现典型的“马蹄征”；81个病灶可见邻近软脑膜强化；40个病灶周围室管膜呈现强化；23个病灶内或周围出现包绕血管征,常规MRI增强和3D对以上征象的显示率分别为(17.1%、34.7%；34.3%、32.0%; 14.3%、32%； 、 10.0%； 18.7%)。结论：PCNSL的MR表现具有特征性,3D增强多平面重建技术可以提供更多的诊断信息,有助于提高该病诊断准确性。第二部分rADC值在原发性中枢神经系统淋巴瘤鉴别诊断中的价值研究目的：探讨病灶实质部分相对最小表观扩散系数(rADC)值在颅内PCNSL、GBM及炎性脱髓鞘鉴别诊断中的价值。方法：搜集术后病理确诊的PCNSL39例共47个病灶,GBM35例共42个病灶,炎性脱髓鞘8例共12个病灶的影像学资料,包括常规MRI平扫、增强扫描和弥散加权成像(DWI),测量病灶实质区最小ADC值及病灶对侧正常脑白质区的平均ADC值,并计算两者的比值相对最小ADC(rADC)。对三组病变的相对表观扩散系数(rADC)值进行方差分析,并进行两两比较；另应用受试者工作特征(R0C)曲线,对rADC值在PCNSL与非PCNSL的诊断效能进行评价。结果：颅内淋巴瘤的病灶实质rADC值低于GBM, GBM病灶实质rADC值低于颅内炎性脱髓鞘,差异有统计学意义(F=20.249,P=0.000)；通过Dunnett T3检验进行两两比较,各组间差异均有统计学意义(P0.05); ROC曲线下面积为0.803,面积的标准误为0.048,用rADC值判定淋巴瘤与非淋巴瘤有显著意义(P=-0.000)。取Youden指数最大值时为判断预后的最佳临界点,即rADC值为0.722时,诊断敏感性0.745,特异性为0.741。结论：病灶实质部分相对最小ADC值(rADC)有助于颅内淋巴瘤、胶质母细胞瘤及炎性脱髓鞘的鉴别诊断,结合DWI图像及常规MRI平扫+增强可以提高淋巴瘤的诊断。
[Abstract]:Part I: MR features of primary central nervous system lymphoma and the value of 3D enhanced multiplanar reconstruction objective: to investigate the (primary central nervous system lymphoma, PCNSL) conventional MRI signs of primary central nervous system lymphoma with normal immune function The value of image and 3D multiplanar reconstruction in diagnosis. Methods: the MRI features of 93 cases of PCNSL proved by pathology or puncture were analyzed retrospectively. Among them, 41 cases were examined by conventional enhanced scan and 40 cases by 3D multiplanar reconstruction. The detection rates of typical PCNSL signs after conventional MR enhancement and 3D multiplanar reconstruction were compared. Results: all the 93 patients were B-cell non-Hodgkin's lymphoma. 49 cases (52.6%) were single, 44 cases (47.3%) were multiple, 167 lesions were detected. Most of the lesions were located on the supratentorial stage (85%). 142 lesions were located on the supratentorial stage and 25 at the subtentorial level. It was mainly distributed in the proximal middle line of the deep white matter and near the meningeal surface. The T1WI of plain scan lesions showed iso-or slightly low signal intensity on T2WI, and all 159 lesions showed high or slightly high signal intensity on DWI. After enhancement, 163 lesions showed mass, nodular enhancement, 4 lesions without enhancement, 8 lesions with "butterfly sign", 43 lesions with typical "horseshoe sign", 81 lesions with adjacent pial meningeal enhancement. The enhancement of ependymal membrane around 40 lesions and the appearance of surrounding vascular signs in or around the lesions were observed in 23 lesions. The display rates of the above signs by conventional MRI enhancement and 3D were (17.1and 34.734.73cm 32.0; 14.33232; 10.0; 18.7% respectively). ConclusionThe MR features of the MR are characterized by 3D enhanced multiplanar reconstruction, which can provide more diagnostic information and help to improve the diagnostic accuracy of the disease. The value of rADC value in differential diagnosis of Primary Central nervous system Lymphoma objective: to investigate the value of the relative minimum apparent diffusion coefficient (rADC) in the differential diagnosis of intracranial PCNSL,GBM and inflammatory demyelination. Methods: the imaging data of 47 PCNSL39 patients with 42 lesions confirmed by pathology and 12 lesions with inflammatory demyelination were collected, including routine MRI plain scan. Contrast-enhanced scanning and diffusion-weighted (DWI), were used to measure the minimum ADC value of the focus parenchyma and the average ADC value of the contralateral normal white matter area, and to calculate the ratio of the two to the minimum ADC (rADC). The relative apparent diffusion coefficient (rADC) of the three groups was analyzed and compared, and the diagnostic efficacy of rADC in PCNSL and non-PCNSL was evaluated by using R0C curve. Results: the rADC value of the lesion parenchyma of intracranial lymphoma was lower than that of GBM, GBM, and the value of rADC was lower than that of intracranial inflammatory demyelination (F _ (20.249) P ~ (0.000), and the difference was statistically significant (F _ (20.249) P ~ (0.000), and compared by Dunnett T _ 3 test. There were significant differences among the groups (P0.05 area under the); ROC curve was 0.803, the standard error of area was 0.048, the rADC value to determine lymphoma and non-lymphoma has significant significance (P0. 000). When the maximum Youden index is taken as the best critical point for prognosis, the diagnostic sensitivity is 0.745 and the specificity is 0.741when the rADC value is 0.722. Conclusion: the relative minimum ADC value of the lesion is helpful to the differential diagnosis of intracranial lymphoma glioblastoma and inflammatory demyelinating. Combined with DWI images and conventional MRI enhancement can improve the diagnosis of lymphoma.
【学位授予单位】：复旦大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R739.4;R445.2
本文编号：2237821
[Abstract]:Part I: MR features of primary central nervous system lymphoma and the value of 3D enhanced multiplanar reconstruction objective: to investigate the (primary central nervous system lymphoma, PCNSL) conventional MRI signs of primary central nervous system lymphoma with normal immune function The value of image and 3D multiplanar reconstruction in diagnosis. Methods: the MRI features of 93 cases of PCNSL proved by pathology or puncture were analyzed retrospectively. Among them, 41 cases were examined by conventional enhanced scan and 40 cases by 3D multiplanar reconstruction. The detection rates of typical PCNSL signs after conventional MR enhancement and 3D multiplanar reconstruction were compared. Results: all the 93 patients were B-cell non-Hodgkin's lymphoma. 49 cases (52.6%) were single, 44 cases (47.3%) were multiple, 167 lesions were detected. Most of the lesions were located on the supratentorial stage (85%). 142 lesions were located on the supratentorial stage and 25 at the subtentorial level. It was mainly distributed in the proximal middle line of the deep white matter and near the meningeal surface. The T1WI of plain scan lesions showed iso-or slightly low signal intensity on T2WI, and all 159 lesions showed high or slightly high signal intensity on DWI. After enhancement, 163 lesions showed mass, nodular enhancement, 4 lesions without enhancement, 8 lesions with "butterfly sign", 43 lesions with typical "horseshoe sign", 81 lesions with adjacent pial meningeal enhancement. The enhancement of ependymal membrane around 40 lesions and the appearance of surrounding vascular signs in or around the lesions were observed in 23 lesions. The display rates of the above signs by conventional MRI enhancement and 3D were (17.1and 34.734.73cm 32.0; 14.33232; 10.0; 18.7% respectively). ConclusionThe MR features of the MR are characterized by 3D enhanced multiplanar reconstruction, which can provide more diagnostic information and help to improve the diagnostic accuracy of the disease. The value of rADC value in differential diagnosis of Primary Central nervous system Lymphoma objective: to investigate the value of the relative minimum apparent diffusion coefficient (rADC) in the differential diagnosis of intracranial PCNSL,GBM and inflammatory demyelination. Methods: the imaging data of 47 PCNSL39 patients with 42 lesions confirmed by pathology and 12 lesions with inflammatory demyelination were collected, including routine MRI plain scan. Contrast-enhanced scanning and diffusion-weighted (DWI), were used to measure the minimum ADC value of the focus parenchyma and the average ADC value of the contralateral normal white matter area, and to calculate the ratio of the two to the minimum ADC (rADC). The relative apparent diffusion coefficient (rADC) of the three groups was analyzed and compared, and the diagnostic efficacy of rADC in PCNSL and non-PCNSL was evaluated by using R0C curve. Results: the rADC value of the lesion parenchyma of intracranial lymphoma was lower than that of GBM, GBM, and the value of rADC was lower than that of intracranial inflammatory demyelination (F _ (20.249) P ~ (0.000), and the difference was statistically significant (F _ (20.249) P ~ (0.000), and compared by Dunnett T _ 3 test. There were significant differences among the groups (P0.05 area under the); ROC curve was 0.803, the standard error of area was 0.048, the rADC value to determine lymphoma and non-lymphoma has significant significance (P0. 000). When the maximum Youden index is taken as the best critical point for prognosis, the diagnostic sensitivity is 0.745 and the specificity is 0.741when the rADC value is 0.722. Conclusion: the relative minimum ADC value of the lesion is helpful to the differential diagnosis of intracranial lymphoma glioblastoma and inflammatory demyelinating. Combined with DWI images and conventional MRI enhancement can improve the diagnosis of lymphoma.
【学位授予单位】：复旦大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R739.4;R445.2
【共引文献】
相关硕士学位论文 前1条
1 唐洁;DWI在肺癌脑转移和脑胶质瘤诊断和鉴别诊断中的应用[D];昆明医科大学;2014年
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