摘要
目的探讨表观扩散系数(ADC)全域直方图分析鉴别脑原发淋巴瘤和脑单发转移瘤的价值。方法回顾性分析经手术病理证实的58例颅内单发肿瘤患者资料,其中脑原发淋巴瘤30例、脑单发转移瘤28例。提取ADC图像上肿瘤的直方图特征,找出两者的显著性差异。结果脑原发淋巴瘤和脑单发转移瘤的ADC直方图平均值、方差、偏度、第10、50、90、99百分位数具有显著统计学差异(P<0.05),其中第90、99百分位数的诊断效能较高,灵敏度均为92.9%,特异度分别为66.7%和60.0%。结论 ADC全域直方图分析有助于鉴别脑原发淋巴瘤和脑单发转移瘤,第90、99百分位数具有较高诊断价值。
Objective To investigate the diagnostic value of the whole-tumor histogram analysis derived from apparent diffusion coefficient(ADC) in differentiating primary intracranial lymphoma from single intracranial metastases. Methods Retrospective analysis of 58 cases of pathologically confirmed intracranial tumors,including 30 cases of primary intracranial lymphoma and 28 cases of single intracranial metastases. The collection of the two kinds of tumor ADC images and histogram analysis for the tumor tissues region were analyzed to find out the significant differences between the two kinds of tumors. Results The mean,variance, skewness and the 10,50,90 and 99 percentile characteristics were statistically significant(P<0.05)between primary intracranial lymphoma and single intracranial metastases. The 90 and 99 percentile identification of the two groups were the more effective and the sensitivities of the 90 and 99 percentile were both 92.9% whereas the specificities were 66.7% and 60.0%. Conclusion Histogram analysis is helpful for the identification of primary intracranial lymphoma and single intracranial metastases, and the 90 and 99 percentile have higher diagnostic value.
引文
1 Ma JH,Kim HS,Rim NJ,et al.Differentiation among glioblastomamultiforme,solitary metastatic tumor,and lymphoma using whole-tumor histogram analysis of the normalized cerebral blood volume in enhancing and perienhancing lesions[J].AJNR,2010,31:1699-1706.
2 王敏红,冯湛.MR纹理分析鉴别诊断脑胶质母细胞瘤和单发转移瘤的价值[J].中国医学影像技术,2017,33:1784-1787.
3 韩秋月,武江芬,鲁珊珊,等.DCE-MRI直方图分析在脑胶质瘤分级中的应用[J].中国医学计算机成像杂志,2017,23:7-12.
4 任继亮,吴颖为,陶晓峰.常规MRI纹理分析鉴别诊断眼眶淋巴瘤与炎性假瘤[J].中国医学影像技术,2017,33:980-984.
5 Just N.Improving tumour heterogeneity MRI assessment with histograms[J].Br J Cancer,2014,111:2205-2213.
6 王萍,李培岭,曾南林.DWI在恶性胶质瘤和单发脑转移瘤鉴别中的应用研究[J].国际医学放射学杂志,2013,36:431-434.
7 金观桥,苏丹柯,罗殿中,等.表观扩散系数直方图预测局部晚期乳腺癌患者新辅助化疗疗效的价值[J].中华放射学杂志,2015,49:491-494.
8 Wu CJ,Wang Q,Li H,et al.DWI-associated entire-tumor histogram analysis for the differentiation of low-grade prostate cancer from intermediate-high-grade prostate cancer[J].Abdom Imaging,2015,40:3214-3121.
9 Schob S,Meyer HJ,Pazaitis N,et al.ADC Histogram Analysis of Cervical Cancer Aids Detecting Lymphatic Metastases-a Preliminary Study[J].MolImagingBiol,2017,19:953-962.
10 Lee S,Choi SH,Ryoo I,et al.Evaluation of the microenvironmental heterogeneity in high-grade gliomas with IDH1/2 gene mutation using histogram analysis of diffusion-weighted imaging and dynamic-susceptibility contrast perfusion imaging[J].JNeurooncol,2014,121:141-150.
11 陈杰云,林晓莹,陈向荣,等.MR灌注加权成像鉴别诊断单发脑转移瘤与高级别胶质瘤[J].中国医学影像技术,2015,31:215-218.
12 Malikova H,Koubska E,Weichet J,et al.Can morphological MRI differentiate between primary central nervous system lymphoma and glioblastoma?[J].Cancer Imaging,2016,16:40.
13 Lu SS,Kim SJ,Kim N,et al.Histogram analysis of apparent diffusion coefficient maps for differentiating primary CNS lymphomas from tumefactive demyelinating lesions[J].AJR,2015,204:827-834.
14 程岗,章翔.原发性中枢神经系统淋巴瘤[J].中华神经外科疾病研究杂志,2013,12:382-384.
15 佘春华,谈丽彩,李鹏,等.30例原发性中枢神经系统淋巴瘤患者的临床特征及预后分析[J].中华血液学杂志,2015,36:282-285.
16 卢昊,冯全志,程乾胜,等.DSC-MRI鉴别诊断胶质母细胞瘤、单发脑转移瘤及脑淋巴瘤[J].中国医学影像技术,2017,33:1185-1189.
17 赵鑫,赵俊锋,肖宜昌,等.原发性中枢神经系统淋巴瘤的1H-MRS表现特点[J].华中科技大学学报(医学版),2017,46:210-213.
18 Shim WH,Kim HS,Choi CG,et al.Comparison of Apparent Diffusion Coefficient and Intravoxel Incoherent Motion for Differentiating among Glioblastoma,Metastasis,and Lymphoma Focusing on Diffusion-Related Parameter[J].PLoS One,2015,10:e0134761.
19 刘晓玉,肖道雄,何艳枚,等.联合应用DWI及PWI对脑内肿瘤及瘤周水肿的比较研究[J].临床放射学杂志,2017,36:928-933.
20 Schob S,Münch B,Dieckow J,et al.Whole Tumor Histogram-profiling of Diffusion-Weighted Magnetic Resonance Images Reflects Tumorbiological Features of Primary Central Nervous System Lymphoma[J].TranslOncol,2018,11:504-510.
21 Lambregts DM,Martens MH,Quah RC,et al.Whole-liver diffusion-weighted MRI histogram analysis:effect of the presence of colorectal hepatic metastases on the remaining liver parenchyma[J].Eur J GastroenterolHepatol,2015,27:399-404.
22 Andersen MB,Harders SW,Ganeshan B,et al.CT texture analysis can help differentiate between malignant and benign lymph nodes in the mediastinum in patients suspected for lung cancer[J].ActaRadiol,2016,3:669-676.