探讨磁共振磁敏感加权成像(SWI)对脑膜、脑转移瘤的诊断价值
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摘要
目的探讨磁共振磁敏感加权成像(SWI)对脑膜、脑转移瘤的诊断价值。方法随机选取2016年3月—2018年3月我院收治的经临床、病理确诊的50例脑膜、脑转移瘤患者为研究对象,所有患者除常规行T1WI、T2WI扫描及T1WI增强扫描检查外,额外进行SWI检查。观察不同来源脑转移瘤转移部位、肿瘤实质信号在不同成像序列上的特征及对瘤内血管情况和出血状况的判断。结果脑转移瘤的发生部位多为顶叶(29.75%)和枕叶(20.66%),就血供区域而言,多发生于中动脉(45.45%)和颈内动脉供血区域(38.02%)。不同MRI成像序列中肿瘤信号特征比较,显示均有差异(P<0.001)。其中,肺癌脑转移瘤T1WI呈低信号(62.96%),胃癌T2WI呈现高信号(68.75%),SWI成像序列上多显示为混杂信号。SWI序列成像显示瘤内出血55例(45.45%),显示引流血管16条,瘤内出血及肿瘤血管检出率均明显高于T1WI平扫检查,差异有统计学意义(P<0.05)。结论不同来源的脑转移瘤MR的表现不同,为逆向推测脑转移瘤来源提供依据,同时SWI是对常规序列的重要补充,尤其是在脑瘤出血和血管检出上有重要作用,值得临床推广使用。
Objective To investigate the diagnostic value of susceptibility-weighted imaging(SWI) in meningiomas and brain metastases. Methods 50 cases of clinically and pathologically confirmed patients with meningioma and brain metastasis admitted to our hospital from March 2016 to March 2018 were randomly selected as the study subjects. All patients received routine T1 WI, T2 WI scan and T1 WI enhanced scan, and additional SWI examination was performed. We observed the characteristics of metastatic sites and tumor parenchymal signals in different imaging sequences of brain metastatic tumors from different sources and to judge the status of intramedullary blood vessels and bleeding. Results The majority of brain metastatic tumors occurred in the parietal lobe(29.75%) and occipital lobe(20.66%). In terms of the blood supply region, the majority occurred in the middle artery(45.45%) and the blood supply region of the lower artery(38.02%). Comparison of tumor signal characteristics in different MRI imaging sequences showed differences, P<0.001. Among them, T1 WI of brain metastatic tumor of lung cancer presented significantly low signal(62.96%), T2 WI of gastric cancer presented high signal(68.75%), and SWI imaging sequence mostly showed mixed signal.SWI sequence imaging were showed in 55 cases(45.45%) of intracranial hemorrhage and 16 drainage vessels. The detection rate of intracranial hemorrhage and tumor blood vessels was higher than that of T1 WI plain scan, with statistically difference(P<0.05). Conclusion MR manifestations of brain metastatic tumors from different sources are different, providing a basis for reverse speculation of the source of brain metastatic tumors. At the same time, SWI is an important supplement to routine sequences, especially in the hemorrhage of brain tumors and the detection of blood vessels, which is worthy of clinical promotion and use.
Objective To investigate the diagnostic value of susceptibility-weighted imaging(SWI) in meningiomas and brain metastases. Methods 50 cases of clinically and pathologically confirmed patients with meningioma and brain metastasis admitted to our hospital from March 2016 to March 2018 were randomly selected as the study subjects. All patients received routine T1 WI, T2 WI scan and T1 WI enhanced scan, and additional SWI examination was performed. We observed the characteristics of metastatic sites and tumor parenchymal signals in different imaging sequences of brain metastatic tumors from different sources and to judge the status of intramedullary blood vessels and bleeding. Results The majority of brain metastatic tumors occurred in the parietal lobe(29.75%) and occipital lobe(20.66%). In terms of the blood supply region, the majority occurred in the middle artery(45.45%) and the blood supply region of the lower artery(38.02%). Comparison of tumor signal characteristics in different MRI imaging sequences showed differences, P<0.001. Among them, T1 WI of brain metastatic tumor of lung cancer presented significantly low signal(62.96%), T2 WI of gastric cancer presented high signal(68.75%), and SWI imaging sequence mostly showed mixed signal.SWI sequence imaging were showed in 55 cases(45.45%) of intracranial hemorrhage and 16 drainage vessels. The detection rate of intracranial hemorrhage and tumor blood vessels was higher than that of T1 WI plain scan, with statistically difference(P<0.05). Conclusion MR manifestations of brain metastatic tumors from different sources are different, providing a basis for reverse speculation of the source of brain metastatic tumors. At the same time, SWI is an important supplement to routine sequences, especially in the hemorrhage of brain tumors and the detection of blood vessels, which is worthy of clinical promotion and use.
引文
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[8] 许开喜,陈新建,左涛生,等.3.0T磁共振的SWI和MRA对小脑急性缺血性卒中的血栓形成及责任血管关系研究 [J].中国临床医学影像杂志,2016,28(1):1- 4.
[9] FRANCESCHI A M,MOSCHOS S J,ANDERS C K,et al.Use of susceptibility-weighted imaging (swi) in the detection of brain hemorrhagic metastases from breast cancer and melanoma [J].J Comput Assist Tomogr,2016,40(5):1.
[10] FU J H,CHUANG T C,CHUNG H W,et al.Discriminating pyogenic brain abscesses,necrotic glioblastomas,and necrotic metastatic brain tumors by means of susceptibility-weighted imaging [J].Eur Radiol,2015,25(5):1413-1420.
[11] 高晓嵘,高亚军,高慧,等.磁敏感加权成像对脑微出血的检测及脑微出血与认知功能障碍关系的研究 [J].广西医科大学学报,2016,33(1):74-76.
[12] 马伦,白岩,刘太元,等.磁敏感加权成像在坏死性脑胶质瘤与脑脓肿鉴别诊断中的价值 [J].磁共振成像,2017,8(11):817-821.
[13] VARON D,SIMONS M,CHIANG F,et al.Brain radiation-related black dots on susceptibility-weighted imaging [J].Neuroradiol J,2014,27(4):445- 451.
[2] MUCCIO C F,TARANTINO A,ESPOSITO G,et al.Differential diagnosis by unenhanced FLAIR T2-weighted magnetic resonance images between solitary high grade gliomas and cerebral metastases appearing as contrast-enhancing cortico-subcortical lesions [J].J Neurooncol,2011,103(3):713-717.
[3] 刘子姗,詹茸婷,王明磊,等.磁敏感加权成像在肺癌脑转移瘤诊断中的应用价值 [J].中国医学计算机成像杂志,2016,22(3):198-203.
[4] 梁爽,张凤翔.磁敏感加权成像在肺癌脑转移瘤中的应用价值 [J].实用医学影像杂志,2017,18(1):7-11.
[5] BETTE S,GEMPT J,WIESTLER B,et al.Increase in FLAIR signal of the fluid within the resection cavity as early recurrence marker:also valid for brain metastases?[J].Fortschr R?ntgenstr,2016,189(1):63-70.
[6] KUCHCINSKI G,RHUN E L,CORTOT A B,et al.Dynamic contrast-enhanced MR imaging pharmacokinetic parameters as predictors of treatment response of brain metastases in patients with lung cancer [J].Eur Radiol,2017,27(9):1-11.
[7] 邹志孟,张帅,曹庆勇,等.MR磁敏感加权成像在评价创伤性颈髓损伤患者颈髓出血中的应用价值 [J].中华放射学杂志,2016,50(5):344-347.
[8] 许开喜,陈新建,左涛生,等.3.0T磁共振的SWI和MRA对小脑急性缺血性卒中的血栓形成及责任血管关系研究 [J].中国临床医学影像杂志,2016,28(1):1- 4.
[9] FRANCESCHI A M,MOSCHOS S J,ANDERS C K,et al.Use of susceptibility-weighted imaging (swi) in the detection of brain hemorrhagic metastases from breast cancer and melanoma [J].J Comput Assist Tomogr,2016,40(5):1.
[10] FU J H,CHUANG T C,CHUNG H W,et al.Discriminating pyogenic brain abscesses,necrotic glioblastomas,and necrotic metastatic brain tumors by means of susceptibility-weighted imaging [J].Eur Radiol,2015,25(5):1413-1420.
[11] 高晓嵘,高亚军,高慧,等.磁敏感加权成像对脑微出血的检测及脑微出血与认知功能障碍关系的研究 [J].广西医科大学学报,2016,33(1):74-76.
[12] 马伦,白岩,刘太元,等.磁敏感加权成像在坏死性脑胶质瘤与脑脓肿鉴别诊断中的价值 [J].磁共振成像,2017,8(11):817-821.
[13] VARON D,SIMONS M,CHIANG F,et al.Brain radiation-related black dots on susceptibility-weighted imaging [J].Neuroradiol J,2014,27(4):445- 451.