磁共振成像
磁共振成像
자공진성상
CHINESE JOURNAL OF MAGNETIC RESONANCE IMAGING
2015年
4期
246-252
,共7页
王微微%牛田力%苗延巍%宋清伟%魏强%贺振飞%刘爱连
王微微%牛田力%苗延巍%宋清偉%魏彊%賀振飛%劉愛連
왕미미%우전력%묘연외%송청위%위강%하진비%류애련
星形细胞瘤%脑肿瘤%肿瘤转移%磁共振成像
星形細胞瘤%腦腫瘤%腫瘤轉移%磁共振成像
성형세포류%뇌종류%종류전이%자공진성상
Astrocytoma%Brain neoplasms%Neoplasm metastasis%Magnetic resonance imaging
目的:应用磁敏感加权成像(susceptibility weighted imaging, SWI)对脑肿瘤瘤体实质的血管及微出血状态进行量化分析,探讨其对星形细胞瘤分级及其与单发脑转移瘤鉴别诊断的价值。材料与方法对42例经手术及病理证实的脑肿瘤患者行常规MRI序列及SWI检查,包括星形细胞瘤Ⅰ级3例、Ⅱ级8例、Ⅲ级9例、Ⅳ级8例及转移瘤14例。SWI原始数据经处理得到滤过后相位图(CPI)、SWI最小密度投影图(SWIMinIP)。将SWIMinIP上肿瘤实质内线状或点状低信号结构定义为肿瘤内磁敏感信号(ITSS),计数肿瘤内所有层面ITSS数。星形细胞瘤不同级别之间、星形细胞瘤与转移瘤之间的ITSS差异用Wilcoxon检验进行分析。对于肿瘤之间有统计学差异的参数,采用ROC曲线分析其诊断敏感度、特异度。应用Spearman相关性分析星形细胞瘤级别与ITSS关系。结果Ⅰ级星形细胞瘤瘤内实质的ITSS数目均值为(3.00±2.65),Ⅱ级为(4.12±0.64),Ⅲ级为(18.11±2.15),Ⅳ级为(18.75±2.48)。Ⅱ级与Ⅲ级星形细胞瘤之间ITSS数目有显著差异(H=7.835, P<0.01);Ⅲ级与Ⅳ级之间ITSS无显著差异(H=0.021,P=0.885)。低级别(Ⅰ级与Ⅱ级)星形细胞瘤的ITSS明显小于高级别星形细胞瘤(Ⅲ级与Ⅳ级;H=13.156, P<0.01)。星形细胞瘤级别与ITSS呈正相关(r=0.746,P=0.000)。以7.5为鉴别高、低级别星形细胞瘤的ITSS阈值,敏感度为88.2%,特异度为81.8%,ROC曲线下面积(AUC)为0.912;以6.0为阈值鉴别Ⅱ级与Ⅲ级星形细胞瘤,敏感度为100%,特异度为87.5%,AUC为0.903。高级别星形细胞瘤瘤内实质的ITSS均值(18.41±1.58)明显高于转移瘤(6.14±1.56,P=0.001);以6.5为鉴别阈值,敏感度为94.1%,特异度为71.4%,AUC为0.861。结论肿瘤实质ITSS数量反映了肿瘤的微血管异质性,有助于星形细胞瘤的分级及其与转移瘤的鉴别诊断。
目的:應用磁敏感加權成像(susceptibility weighted imaging, SWI)對腦腫瘤瘤體實質的血管及微齣血狀態進行量化分析,探討其對星形細胞瘤分級及其與單髮腦轉移瘤鑒彆診斷的價值。材料與方法對42例經手術及病理證實的腦腫瘤患者行常規MRI序列及SWI檢查,包括星形細胞瘤Ⅰ級3例、Ⅱ級8例、Ⅲ級9例、Ⅳ級8例及轉移瘤14例。SWI原始數據經處理得到濾過後相位圖(CPI)、SWI最小密度投影圖(SWIMinIP)。將SWIMinIP上腫瘤實質內線狀或點狀低信號結構定義為腫瘤內磁敏感信號(ITSS),計數腫瘤內所有層麵ITSS數。星形細胞瘤不同級彆之間、星形細胞瘤與轉移瘤之間的ITSS差異用Wilcoxon檢驗進行分析。對于腫瘤之間有統計學差異的參數,採用ROC麯線分析其診斷敏感度、特異度。應用Spearman相關性分析星形細胞瘤級彆與ITSS關繫。結果Ⅰ級星形細胞瘤瘤內實質的ITSS數目均值為(3.00±2.65),Ⅱ級為(4.12±0.64),Ⅲ級為(18.11±2.15),Ⅳ級為(18.75±2.48)。Ⅱ級與Ⅲ級星形細胞瘤之間ITSS數目有顯著差異(H=7.835, P<0.01);Ⅲ級與Ⅳ級之間ITSS無顯著差異(H=0.021,P=0.885)。低級彆(Ⅰ級與Ⅱ級)星形細胞瘤的ITSS明顯小于高級彆星形細胞瘤(Ⅲ級與Ⅳ級;H=13.156, P<0.01)。星形細胞瘤級彆與ITSS呈正相關(r=0.746,P=0.000)。以7.5為鑒彆高、低級彆星形細胞瘤的ITSS閾值,敏感度為88.2%,特異度為81.8%,ROC麯線下麵積(AUC)為0.912;以6.0為閾值鑒彆Ⅱ級與Ⅲ級星形細胞瘤,敏感度為100%,特異度為87.5%,AUC為0.903。高級彆星形細胞瘤瘤內實質的ITSS均值(18.41±1.58)明顯高于轉移瘤(6.14±1.56,P=0.001);以6.5為鑒彆閾值,敏感度為94.1%,特異度為71.4%,AUC為0.861。結論腫瘤實質ITSS數量反映瞭腫瘤的微血管異質性,有助于星形細胞瘤的分級及其與轉移瘤的鑒彆診斷。
목적:응용자민감가권성상(susceptibility weighted imaging, SWI)대뇌종류류체실질적혈관급미출혈상태진행양화분석,탐토기대성형세포류분급급기여단발뇌전이류감별진단적개치。재료여방법대42례경수술급병리증실적뇌종류환자행상규MRI서렬급SWI검사,포괄성형세포류Ⅰ급3례、Ⅱ급8례、Ⅲ급9례、Ⅳ급8례급전이류14례。SWI원시수거경처리득도려과후상위도(CPI)、SWI최소밀도투영도(SWIMinIP)。장SWIMinIP상종류실질내선상혹점상저신호결구정의위종류내자민감신호(ITSS),계수종류내소유층면ITSS수。성형세포류불동급별지간、성형세포류여전이류지간적ITSS차이용Wilcoxon검험진행분석。대우종류지간유통계학차이적삼수,채용ROC곡선분석기진단민감도、특이도。응용Spearman상관성분석성형세포류급별여ITSS관계。결과Ⅰ급성형세포류류내실질적ITSS수목균치위(3.00±2.65),Ⅱ급위(4.12±0.64),Ⅲ급위(18.11±2.15),Ⅳ급위(18.75±2.48)。Ⅱ급여Ⅲ급성형세포류지간ITSS수목유현저차이(H=7.835, P<0.01);Ⅲ급여Ⅳ급지간ITSS무현저차이(H=0.021,P=0.885)。저급별(Ⅰ급여Ⅱ급)성형세포류적ITSS명현소우고급별성형세포류(Ⅲ급여Ⅳ급;H=13.156, P<0.01)。성형세포류급별여ITSS정정상관(r=0.746,P=0.000)。이7.5위감별고、저급별성형세포류적ITSS역치,민감도위88.2%,특이도위81.8%,ROC곡선하면적(AUC)위0.912;이6.0위역치감별Ⅱ급여Ⅲ급성형세포류,민감도위100%,특이도위87.5%,AUC위0.903。고급별성형세포류류내실질적ITSS균치(18.41±1.58)명현고우전이류(6.14±1.56,P=0.001);이6.5위감별역치,민감도위94.1%,특이도위71.4%,AUC위0.861。결론종류실질ITSS수량반영료종류적미혈관이질성,유조우성형세포류적분급급기여전이류적감별진단。
Objective: The purpose of this study is to explore the value of the intratumoral susceptibility signal intensity (ITSS) in grading of astrocytoma and in differential diagnosis of astrocytomas and metastases. Materials and Methods:Forty-two recruited patients with brain tumors conifrmed pathologically, including 14 solitary metastases and 28 astrocytomas(WHO grade Ⅰ=3, grade Ⅱ=8, grade Ⅲ=9 and gradeⅣ=8) underwent conventional MRI examinations and susceptibility weighted imaging (SWI). Intratumoral susceptibility signal intensity(ITSS)in tumor parenchyma was obtained. The ITSS values were further compared between different grades of astrocytoma and between astrocytomas and metastases by Wilcoxon test. Receiver operating characteristic curve (ROC) was used to determine the differentiation ability of ITSS number for astrocytoma grading and brain tumors differential diagnosis. Spearman coefficient correlation analysis was used to analyze the relation between ITSS and astrocytoma grade. Results: The mean values of ITSS in grade Ⅰ, Ⅱ,Ⅲ, Ⅳ astrocytomas and metastases were respectively (3.0±2.67), (4.12±0.64),(18.11±2.15), (18.75±2.48) and (6.14±1.56). Significant difference was observed in high-grade (ⅢandⅣ) and low-grade (ⅠandⅡ) astrocytomas (H=13.156, P<0.01), and even between the gradesⅡandⅢastrocytomas (H=7.835, P<0.01), while no signiifcant difference was found between grade ⅢandⅣastrocytomas(H=0.021, P=0.885). Positive correlation was observed between ITSS and astrocytoma grade (r=0.746,P=0.000). Area under the ROC curve (AUC) was 0.912 in differentiation of the high-grade and low-grade astrocytomas when the cutoff value was set as 7.5, and the sensitivity and speciifcity were 88.2% and 81.8%. AUC was 0.903 in differentiation of the gradeⅡand gradeⅢastrocytomas when the cutoff value was set as 6.0, and the sensitivity and speciifcity were 100% and 87.5%. Signiifcant differences of ITSS were observed between the metastases (mean rank=9.89) and high-grade astrocytomas(mean rank=21.06) (H=11.679, P=0.001), while no signiifcant difference was observed between the metastases and low-grade astrocytomas. AUC in differentiation of the high-grade astrocytomas and metastases was 0.861 when the cutoff value of ITSS was set as 6.5, and the sensitivity and speciifcity were 94.1% and 71.4%. Conclusion:ITSS is helpful to determine the grade of astrocytoma and differentiate the high grade astrocytoma and metastates, which relfects the microhemorrhage and tumor vessels in the tumor parenchyma.