DWI联合最小ADC值对鉴别诊断颅内孤立性纤维性肿瘤/血管外皮细胞瘤与脑膜瘤的价值
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摘要
目的用扩散加权成像(diffusion weighted imaging,DWI)联合最小表观扩散系数(minimum apparent diffusion coefficient,MinADC)值鉴别诊断颅内孤立性纤维性肿瘤/血管外皮细胞瘤(solitary fibrous tumor/hemangiopericytoma,SFT/HPC)与脑膜瘤,以提高术前诊断准确率。材料与方法回顾性分析2012年3月至2018年8月我院经手术病理证实的颅内10例SFT/HPC (WHOⅡ级)患者与22例脑膜瘤(WHOⅡ级)患者的术前临床资料、DWI特征及病理资料,在ADC图上测量两者的MinADC值并进行比较。通过Welch检验进行两组MinADC值的比较,运用受试者工作特征曲线(receiver operating characteristiccurve,ROC曲线),评价MinADC值的鉴别诊断价值。结果在10例SFT/HPC中,肿瘤实性成分在DWI上8例呈等信号,2例呈稍高信号,MinADC平均值为(1.16±0.23)×10-3 mm2/s;在22例脑膜瘤中,肿瘤实性成分在DWI上18例呈稍高信号,2例呈等信号,2例明显高信号,MinADC值平均值为(0.80±0.12)×10-3mm2/s,小于SFT/HPC,两组肿瘤实性成分MinADC值比较差异有统计学意义(P<0.01)。以MinADC值0.90×10-3 mm2/s为阈值诊断SFT/HPC与脑膜瘤,ROC曲线下面积为0.92±0.32,敏感度为97.6%,特异度为94.3%,与病理组织学结果行一致性检验,SFT/HPC的重复测量的Kappa值为0.91,脑膜瘤的Kappa值为0.87。结论 MinADC值可以作为一种量化工具区分颅内SFT/HPC与脑膜瘤,提高术前诊断准确率。
Objective: Differential diagnosis of intracranial solitary fibrous tumor/hemangiopericytoma(SFT/HPC) and meningioma by diffusion weighted imaging(DWI) combined with minimum apparent diffusion coefficient(MinADC) to improve preoperative diagnostic accuracy. Materials and Methods: Retrospective analysis of preoperative clinical data, DWI characteristics and pathological data of 10 patients with SFT/HPC(WHO Ⅱ grade) and 22 patients with meningioma(WHO Ⅱ grade) confirmed by surgery and pathology from March 2012 to August 2018. MinADC value of the SFT/HPCs(n=10) was measured on ADC map and was compared with that of meningiomas(n=22). Comparison of MinADC values between SFT/HPC and meningioma was conducted by Welch test. Using the receiver operating characteristic curve(ROC curve) to evaluate the differential diagnosis value of MinADC value. Results: In 10 cases of SFT/HPC, the solid components of the tumor showed equal signal(n=8) and slightly higher signal(n=2) on DWI, the mean value of MinADC was(1.16±0.23)×10-3 mm2/s. In 22 cases of meningioma, the solid components of the tumor showed slightly higher signal(n=18) and equal signal(n=2) and high signal(n=2) on DWI, the mean value of Min ADC was(0.80±0.12)×10-3 mm2/s, less than that of SFT/HPC, the difference of MinADC values between the two groups was statistically significant(P<0.01). For the differentiation between SFT/HPC and meningioma, the critical cutoff MinADC value was 0.90×10-3 mm2/s,which provided the best combination of sensitivity(97.6%) and specificity(94.3%), the area under the ROC curve was 0.92±0.32, corresponding to histopathological findings, the Kappa value of the repeat measurements was 0.91 for SFT/HPC and 0.87 for meningioma, which indicated a good concordance of the results. Conclusions: MinADC value can be used as a quantitative tool to distinguish intracranial SFT/HPC from meningioma and improve the accuracy of preoperative diagnosis.
Objective: Differential diagnosis of intracranial solitary fibrous tumor/hemangiopericytoma(SFT/HPC) and meningioma by diffusion weighted imaging(DWI) combined with minimum apparent diffusion coefficient(MinADC) to improve preoperative diagnostic accuracy. Materials and Methods: Retrospective analysis of preoperative clinical data, DWI characteristics and pathological data of 10 patients with SFT/HPC(WHO Ⅱ grade) and 22 patients with meningioma(WHO Ⅱ grade) confirmed by surgery and pathology from March 2012 to August 2018. MinADC value of the SFT/HPCs(n=10) was measured on ADC map and was compared with that of meningiomas(n=22). Comparison of MinADC values between SFT/HPC and meningioma was conducted by Welch test. Using the receiver operating characteristic curve(ROC curve) to evaluate the differential diagnosis value of MinADC value. Results: In 10 cases of SFT/HPC, the solid components of the tumor showed equal signal(n=8) and slightly higher signal(n=2) on DWI, the mean value of MinADC was(1.16±0.23)×10-3 mm2/s. In 22 cases of meningioma, the solid components of the tumor showed slightly higher signal(n=18) and equal signal(n=2) and high signal(n=2) on DWI, the mean value of Min ADC was(0.80±0.12)×10-3 mm2/s, less than that of SFT/HPC, the difference of MinADC values between the two groups was statistically significant(P<0.01). For the differentiation between SFT/HPC and meningioma, the critical cutoff MinADC value was 0.90×10-3 mm2/s,which provided the best combination of sensitivity(97.6%) and specificity(94.3%), the area under the ROC curve was 0.92±0.32, corresponding to histopathological findings, the Kappa value of the repeat measurements was 0.91 for SFT/HPC and 0.87 for meningioma, which indicated a good concordance of the results. Conclusions: MinADC value can be used as a quantitative tool to distinguish intracranial SFT/HPC from meningioma and improve the accuracy of preoperative diagnosis.
引文
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[12]Liu G,Chen ZY,Ma L,et al.Intracranial hemangiopericytoma:MRimaging findings and diagnostic usefulness of minimum ADC values.JMagn Reson Imaging,2013,38(5):1146-1151.
[13]Cabada T,Caballero MC,Insausti I,et al.The role of diffusion-weighted imaging in the evaluation of meningiomas:radio-pathologic correlation.Radiología,2009,51(4):411.
[14]Nagar VA,Ye JR,Ng WH,et al.Diffusion-weighted MR imaging:diagnosing atypical or malignant meningiomas and detecting tumor dedifferentiation.AJNR Am J Neuroradiol,2008,29(6):1147-1152.
[15]Lee EJ,Terbrugge K,Mikulis D,et al.Diagnostic value of peritumoral minimum apparent diffusion coefficient for differentiation of glioblastoma multiforme from solitary metastatic lesions.AJR Am JRoentgenol,2011,196(1):71-76.
[16]Mo X,Tang XL,Tan CL,et al.Misdiagnosis of atypical meningioma MRImanifestation analysis.Chin J Magn Reson Imaging,2015(4):258-265.莫信,汤小俐,谭长连,等.不典型脑膜瘤MRI表现及误诊分析.磁共振成像,2015(4):258-265.
[17]Yamashita Y,Kumabe T,Higano S,et al.Minimum apparent diffusion coefficient is significantly correlated with cellularity in medulloblastomas.Neurol Res,2009,31(9):940-946
[18]Buakbasi N,Guvenc I,Onguru O,et al.The added value of the apparent diffusion coefficient calculation to magnetic resonance imaging in the differentiation and grading of malignant brain tumors.J Comput Assist Tomogr,2004,28(6):735-746.
[19]Chen F,Shen XJ,Ma L,et al.Imaging and ADC value in differential diagnosis of intracranial hemangiopericytoma and anaplastic meningioma:a comparative study.Chin J Magn Reson Imaging,2016,7(11):813-818.陈菲,沈雪娇,马莉,等.颅内血管外皮细胞瘤与不典型脑膜瘤的影像对比研究及ADC值鉴别诊断价值.磁共振成像,2016,7(11):813-818.
[20]Li Q,Zhou BJ,He HJ,et al.Application of ADC values in differentiating hemangiopericytomas from meningiomas.Chin Comput Med Imag,2015,21(5):419-425.李桥,周碧婧,何慧瑾,等.ADC值在鉴别血管外皮细胞瘤与脑膜瘤中的应用.中国医学计算机成像杂志,2015,21(5):419-425.
[2]Chen Z,Ma L,Lou X,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.
[3]Yang TH,Lin JZ,Wang X,et al.Preliminary study of feasibility of whole body diffusion weighted imaging in diagnosis of metastasis of tumor.J Chin Oncol,2008,18(2):145-148.杨天和,林建忠,王馨,等.全身弥散加权成像对肿瘤转移的诊断意义初探.中国癌症杂志,2008,18(2):145-148.
[4]Liu G,Chen ZY,Ma L,et al.Intracranial hemangiopericytoma:MRimaging findings and diagnostic usefulness of minimum ADC values.JMagn Reson Imaging,2013,38(5):1146-1151.
[5]Peng P,Guo DS,Wang BF,et al.Diagnosis and treatment of intracranial meningeal hemangiopericytomas(report of 18 cases).Chin J Clin Neurosurg,2013,18(12):714-716.彭鹏,郭东生,王宝峰,等.颅内脑膜血管周细胞瘤的诊治分析.中国临床神经外科杂志,2013,18(12):714-716.
[6]Charles FB,Rudolf G.Hemangiopericytoma occurring in the meninges.Case report.Cancer,1954,7(3):602-606.
[7]Klemperer P.Primary neoplasms of the pleura:a case report of five cases.Arch Pathol,1931,11:1245-1250.
[8]Louis DN,Perry A,Reifenberger G,et al.The 2016 World Health Organization Classification of tumors of the central nervous system:a summary.Acta Neuropathol,2016,131(6):803-820.
[9]Fountas KN,Kapsalaki E,Kassam M,et al.Management of intracranial meningeal hemangiopericytomas:outcome and experience.Neurosurg Rev,2006,29(2):145-153.
[10]Wu W,Shi JH,Wang H,et al.Hemangiopericytomas in the central nervous system.J Clin Neurosci,2009,16(4):519-523.
[11]Chen Z,Ma L,Lou X,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.
[12]Liu G,Chen ZY,Ma L,et al.Intracranial hemangiopericytoma:MRimaging findings and diagnostic usefulness of minimum ADC values.JMagn Reson Imaging,2013,38(5):1146-1151.
[13]Cabada T,Caballero MC,Insausti I,et al.The role of diffusion-weighted imaging in the evaluation of meningiomas:radio-pathologic correlation.Radiología,2009,51(4):411.
[14]Nagar VA,Ye JR,Ng WH,et al.Diffusion-weighted MR imaging:diagnosing atypical or malignant meningiomas and detecting tumor dedifferentiation.AJNR Am J Neuroradiol,2008,29(6):1147-1152.
[15]Lee EJ,Terbrugge K,Mikulis D,et al.Diagnostic value of peritumoral minimum apparent diffusion coefficient for differentiation of glioblastoma multiforme from solitary metastatic lesions.AJR Am JRoentgenol,2011,196(1):71-76.
[16]Mo X,Tang XL,Tan CL,et al.Misdiagnosis of atypical meningioma MRImanifestation analysis.Chin J Magn Reson Imaging,2015(4):258-265.莫信,汤小俐,谭长连,等.不典型脑膜瘤MRI表现及误诊分析.磁共振成像,2015(4):258-265.
[17]Yamashita Y,Kumabe T,Higano S,et al.Minimum apparent diffusion coefficient is significantly correlated with cellularity in medulloblastomas.Neurol Res,2009,31(9):940-946
[18]Buakbasi N,Guvenc I,Onguru O,et al.The added value of the apparent diffusion coefficient calculation to magnetic resonance imaging in the differentiation and grading of malignant brain tumors.J Comput Assist Tomogr,2004,28(6):735-746.
[19]Chen F,Shen XJ,Ma L,et al.Imaging and ADC value in differential diagnosis of intracranial hemangiopericytoma and anaplastic meningioma:a comparative study.Chin J Magn Reson Imaging,2016,7(11):813-818.陈菲,沈雪娇,马莉,等.颅内血管外皮细胞瘤与不典型脑膜瘤的影像对比研究及ADC值鉴别诊断价值.磁共振成像,2016,7(11):813-818.
[20]Li Q,Zhou BJ,He HJ,et al.Application of ADC values in differentiating hemangiopericytomas from meningiomas.Chin Comput Med Imag,2015,21(5):419-425.李桥,周碧婧,何慧瑾,等.ADC值在鉴别血管外皮细胞瘤与脑膜瘤中的应用.中国医学计算机成像杂志,2015,21(5):419-425.