瘤周水肿区最小表观扩散系数值在原发中枢神经系统淋巴瘤与胶质母细胞瘤中的鉴别诊断价值
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摘要
目的探讨磁共振扩散加权成像瘤周水肿区最小表观扩散系数(MinADC)值对原发中枢神经系统淋巴瘤与胶质母细胞瘤的鉴别诊断价值。方法分析经病理证实的16例原发中枢神经系统淋巴瘤(弥漫大B细胞淋巴瘤)和31例胶质母细胞瘤(WHOⅣ级)的瘤周水肿区MinADC值。在表观扩散系数图上采用感兴趣区法测量瘤周水肿区表观扩散系数值,并获得MinADC值。采用独立样本t检验及受试者操作特征曲线分析。结果原发中枢神经系统淋巴瘤MinADC值[(1.20~1.45)×10~(-3)mm~2/s,平均(1.35±0.68)×10~(-3)mm~2/s]明显高于胶质母细胞瘤[(0.95~1.31)×10~(-3)mm~2/s,平均(1.12±0.09)×10~(-3)mm~2/s](t=9.977,P=0.000)。受试者操作特征曲线下面积为0.986,鉴别原发中枢神经系统淋巴瘤和胶质母细胞瘤的MinADC值最佳截断点为1.245×10~(-3)mm~2/s,其灵敏度和特异度分别为94.1%和94.1%。结论 MinADC值可以作为鉴别原发中枢神经系统淋巴瘤与胶质母细胞瘤的简单有效的方法。
Objective To evaluate the role of minimum apparent diffusion coefficient( MinADC) values in peritumoral edema based on magnetic resonance diffusion weighted imaging in the differential diagnosis between primary central nervous system lymphoma( PCNSL) and glioblastoma( GBM). Methods ADC values in peritumoral edema were measured in 16 patients with PCNSL( diffuse large B cell lymphoma) and 31 patientswith GBM( WHO grade Ⅳ) confirmed by pathology. Regions of interests were manually drawn on ADC maps on peritumoral edema regions to obtain the MinADC value. Independent samples t-test and receiver operating characteristic analysis were performed for statistical analysis. Results The MinADC value [( 1. 20-1. 45) × 10~(-3) mm~2/s,mean( 1. 35 ± 0. 68) × 10~(-3) mm~2/s] in PCNSL was significantly higher than that in GBM [( 0. 95-1. 31) ×10~(-3) mm~2/s,mean( 1. 12 ± 0. 09) × 10~(-3) mm~2/s]( t = 9. 977,P = 0. 000). The area under the receiver operating characteristic curve was 0. 986,and the cutoff value of MinADC was 1. 245 × 10~(-3) mm~2/s for the differentiation between PCNSL and GBM, with the best combination of sensitivity( 94. 1%) and specificity( 94. 1%). Conclusion MinADC value can be a simple and effective measure for the differential diagnosis between PCNSL and GBM.
Objective To evaluate the role of minimum apparent diffusion coefficient( MinADC) values in peritumoral edema based on magnetic resonance diffusion weighted imaging in the differential diagnosis between primary central nervous system lymphoma( PCNSL) and glioblastoma( GBM). Methods ADC values in peritumoral edema were measured in 16 patients with PCNSL( diffuse large B cell lymphoma) and 31 patientswith GBM( WHO grade Ⅳ) confirmed by pathology. Regions of interests were manually drawn on ADC maps on peritumoral edema regions to obtain the MinADC value. Independent samples t-test and receiver operating characteristic analysis were performed for statistical analysis. Results The MinADC value [( 1. 20-1. 45) × 10~(-3) mm~2/s,mean( 1. 35 ± 0. 68) × 10~(-3) mm~2/s] in PCNSL was significantly higher than that in GBM [( 0. 95-1. 31) ×10~(-3) mm~2/s,mean( 1. 12 ± 0. 09) × 10~(-3) mm~2/s]( t = 9. 977,P = 0. 000). The area under the receiver operating characteristic curve was 0. 986,and the cutoff value of MinADC was 1. 245 × 10~(-3) mm~2/s for the differentiation between PCNSL and GBM, with the best combination of sensitivity( 94. 1%) and specificity( 94. 1%). Conclusion MinADC value can be a simple and effective measure for the differential diagnosis between PCNSL and GBM.
引文
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[23]Blystad I,Warntjes JBM,Smedby O,et al.Quantitative MRI for analysis of peritumoral edema in malignant gliomas[J].PLo S One,2017,12(5):e0177135.DOI:10.1371/journal.pone.0177135.
[24]Halshtok Neiman O,Sadetzki S,Chetrit A,et al.Perfusion-weighted imaging of peritumoral edema can aid in the differential diagnosis of glioblastoma mulltiforme versus brain metastasis[J].Isr Med Assoc J,2013,15(2):103-105.
[2]Schlegel U.Primary CNS lymphoma[J].Ther Adv Neurol Disord,2009,2(2):93-104.DOI:10.1177/1756285608101222.
[3]Kickingereder P,Wiestler B,Sahm F,et al.Primary central nervous system lymphoma and atypical glioblastoma:multiparametric differentiation by using diffusion-,perfusion-,and susceptibility-weighted MR imaging[J].Radiology,2014,272(3):843-850.DOI:10.1148/radiol.14132740.
[4]Peters S,Knoss N,Wodarg F,et al.Glioblastomas vs.lymphomas:more diagnostic certainty by using susceptibilityweighted imaging(SWI)[J].Rofo,2012,184(8):713-718.DOI:10.1055/s-0032-1312862.
[5]Matsushima N,Maeda M,Umino M,et al.Relation between FDG uptake and apparent diffusion coefficients in glioma and malignant lymphoma[J].Ann Nucl Med,2012,26(3):262-271.DOI:10.1007/s12149-012-0570-y.
[6]Yamashita K,Kurisu K,Satoh K,et al.Differentiating primary CNS lymphoma from glioblastoma multiforme:assessment using arterial spin labeling,diffusion-weighted imaging,and(1)(8)F-fluorodeoxyglucose positron emission tomography[J].Neuroradiology,2013,55(2):135-143.DOI:10.1007/s00234-012-1089-6.
[7]Lemercier P,Paz Maya S,Patrie JT,et al.Gradient of apparent diffusion coefficient values in peritumoral edema helps in differentiation of glioblastoma from solitary metastatic lesions[J].AJR Am J Roentgenol,2014,203(1):163-169.DOI:10.2214/AJR.13.11186.
[8]Ko CC,Tai MH,Li CF,et al.Differentiation between glioblastoma multiforme and primary cerebral lymphoma:additional benefits of quantitative diffusion-weighted MR imaging[J].PLo S One,2016,11(9):e162565.DOI:10.1371/journal.pone.0162565.
[9]Schoenegger K,Oberndorfer S,Wuschitz B,et al.Peritumoral edema on MRI at initial diagnosis:an independent prognostic factor for glioblastoma?[J].Eur J Neurol,2009,16(7):874-878.DOI:10.1111/j.1468-1331.2009.02613.x.
[10]Wu CX,Lin GS,Lin ZX,et al.Peritumoral edema shown by MRI predicts poor clinical outcome in glioblastoma[J].World J Surg Oncol,2015,13:97.DOI:10.1186/s12957-015-0496-7.
[11]Chawla S,Zhang Y,Wang S,et al.Proton magnetic resonance spectroscopy in differentiating glioblastomas from primary cerebral lymphoma as and brain metastases[J].Comput Assist Tomogr,2010,34(6):836-841.DOI:10.1097/RCT.0b013e3181ec554e.
[12]宋花玲,贺佳,虞慧婷,等.应用ROC曲线下面积对两相关诊断试验进行评价和比较[J].第二军医大学学报,2006,27(5):562-563.DOI:10.3321/j.issn:0258-879X.2006.05.031.
[13]龚道元,伏红霞,彭艳,等.胰腺癌患者血清CEACAM1的测定及其诊断价值[J].南方医科大学学报,2011,31(1):164-166.
[14]Chen Z,Lin M,Xin L,et al.Diagnostic value of minimum apparent diffusion coefficient values in prediction of neuroepithelial tumor grading[J].Magn Reson Imaging,2010,31(6):1331-1338.DOI:10.1002/jmri.22175.
[15]Raisi-Nafchi M,Faeghi F,Zali A,et al.Preoperative grading of astrocytic supratentorial brain tumors with diffusionweighted magnetic resonance imaging and apparent diffusion coefficient[J].Iran J Radiol,2016,13(3):e30426.DOI:10.5812/iranjradiol.30426.
[16]Higano S,Yun X,Kumabe T,et al.Malignant astrocytic tumors:clinical importance of apparent diffusion coefficient in prediction of grade and prognosis[J].Radiology,2006,241(3):839-846.DOI:10.1148/radiol.2413051276.
[17]Gupta PK,Awasthi R,Singh S,et al.Value of minimum apparent diffusion coefficient on magnetic resonance imaging as a biomarker for predicting progression of disease following surgery and radiotherapy in glial tumors from a Tertiary Care Center in Northern India[J].Neurosci Rural Pract,2017,8(2):185-193.DOI:10.4103/0976-3147.203823.
[18]Touitou V,Le Hoang P,Bodaghi B,Primary CNS lymphoma[J].Curr Opin Ophthalmol,2015,26(6):526-533.DOI:10.1097/ICU.0000000000000213.
[19]Sierra del Rio M,Rousseau A,Soussain C,et al.Primary CNS lymphoma inimmunocompetent patients[J].Oncologist,2009,14(5):526-539.DOI:10.1634/theoncologist.2008-0236.
[20]Oh J,Cha S,Aiken AH,et al.Quantitative apparent diffusion coefficients and T2 relaxation times in characterizing contrast enhancing brain tumors and regions of peritumoral edema[J].Magn Reson Imaging,2005,21(6):701-708.DOI:10.1002/jmri.20335.
[21]Giese A,Bjerkvig R,Berens ME,et al.Cost of migration:invasion of malignant gliomas and implications for treatment[J].Clin Oncol,2003,21(8):1624-1636.DOI:10.1200/JCO.2003.05.063.
[22]Claes A,Idema AJ,Wesseling P.Diffuse glioma growth:a guerilla war[J].Acta Neuropathol,2007,114(5):443-458.DOI:10.1007/s00401-007-0293-7.
[23]Blystad I,Warntjes JBM,Smedby O,et al.Quantitative MRI for analysis of peritumoral edema in malignant gliomas[J].PLo S One,2017,12(5):e0177135.DOI:10.1371/journal.pone.0177135.
[24]Halshtok Neiman O,Sadetzki S,Chetrit A,et al.Perfusion-weighted imaging of peritumoral edema can aid in the differential diagnosis of glioblastoma mulltiforme versus brain metastasis[J].Isr Med Assoc J,2013,15(2):103-105.