脑实质结核与脑转移瘤的MRI鉴别及多b值DWI量化分析

发布时间：2018-02-10 20:15

  本文关键词： 颅内结核 脑转移瘤 弥散加权成像 表观扩散系数值　出处：《中国医学计算机成像杂志》2017年01期 　论文类型：期刊论文

【摘要】：目的:分析脑实质结核的MRI特点,探讨多b值弥散加权成像(DWI)对脑实质结核与脑转移瘤鉴别诊断的应用价值。方法:对28例脑实质结核和31例脑转移瘤患者行MRI检查和多b值DWI成像,分析两者的MRI表现,测量实性强化病灶及环形强化病灶的强化环壁、中央坏死的各类表观扩散系数(apparent diffusion coefficient,ADC)值,包括ADC_(10b)、ADC_(high)及ADC_(perf)值,采用两样本t检验。结果:脑实质结核337个病灶,实性均匀强化病灶102个,69.6%≤3.0mm,25.5%在3.0~10.0mm之间;环形强化病灶235个,环壁厚薄均匀光整,32.4%在3.5~5.0mm之间,45.5%在5.0~10.0mm之间,22.1%≥10.0mm。脑转移瘤285个,实性欠均匀强化病灶74个,27.0%≤3.0mm,73.0%3.0mm;环形强化病灶211个,环壁凹凸不平,84.8%5.0mm。脑实质结核中实性强化结节、强化环壁的ADC_(high)值分别为(0.240±0.038)×10~(-3)mm~2/s、(0.249±0.039)×10~(-3)mm~2/s,均高于脑转移瘤,脑实质结核环形强化病灶干酪实性中心区的ADC_(high)值为(0.251±0.056)×10~(-3)mm~2/s,低于脑转移瘤的中心坏死区。环形强化病灶中环壁的ADC_(10b)及ADC_(high)值分别以0.088×10~(-3)mm~2/s和0.241×10~(-3)mm~2/s为界,鉴别脑实质结核与脑转移瘤的灵敏度分别为83.9%、58.9%,特异度分别为72.5%、100%。结论:结合病灶大小、MRI强化方式及ADC_(high)值与ADC_(10b)值的测量有利于脑实质结核和脑转移瘤的鉴别诊断。
[Abstract]:Objective: to analyze the MRI features of cerebral parenchyma tuberculosis. To evaluate the value of DWI in differential diagnosis of cerebral parenchyma tuberculosis and brain metastases. Methods: 28 patients with cerebral parenchyma tuberculosis and 31 patients with brain metastases were examined by MRI and multi-b DWI imaging, and their MRI manifestations were analyzed. The enhancement ring wall of solid and annular enhancement lesions and the apparent diffusion coefficient of central necrosis were measured. The apparent diffusion coefficient of central necrosis was measured, including the value of ADCA 10 BX, ADCC high and ADCP perfuse. The results were as follows: 337 lesions of brain parenchyma tuberculosis, 102 solid homogeneous enhancement lesions (69.6% 鈮，

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