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目的探讨颅内原发性中枢神经系统淋巴瘤(PCNSL)、胶质母细胞瘤(GBM)和炎性脱髓鞘在磁共振扩散加权成像(DWI)检测中的相对表观弥散系数值(rADC值)比较及其与Ki-67阳性率的相关性。方法选取2013年10月至2015年10月间咸阳市第一人民医院收治的87例颅内PCNSL、GBM和炎性脱髓鞘患者,按照病理学确诊结果分为颅内PCNSL组(40例)、GBM组(39例)及炎性脱髓鞘组(8例)。采用磁共振扩散加权成像(DWI)分别对各组患者的相对表观弥散系数值(rADC)进行分析,采用免疫组化法检测各组患者的Ki-67表达,探讨rADC值及其与Ki-67在各组间相关性。结果颅内PCNSL组患者的rADC值(0.68±0.11)×10~(-5)m~2/s均低于GBM组患者的(0.77±0.05)×10~(-5)m~2/s及炎性脱髓鞘组患者的(0.84±0.06)×10~(-5)m~2/s,且差异均有统计学意义(均P<0.05)。颅内PCNSL组、GBM组和炎性脱髓鞘组患者的Ki-67阳性率分别为90.0%、57.5%和25.0%,组间差异有统计学意义(P<0.05)。经相关分析发现,各组患者的rADC值与Ki-67阳性率之间呈负相关,相关系数分别为r_(PCNSL组)=-0.618,r_(GBM组)=-0.624和r_(炎性脱髓鞘组)=0.653。结论采用DWI进行颅内PCNSL、GBM和炎性脱髓鞘的诊断具有鉴别价值,rADC值与Ki-67阳性率呈负相关,为病情恶化程度的判断提供了无创性量化指标。
Objective To investigate the relative apparent diffusion coefficient (rADC) values of intracranial primary central nervous system lymphoma (PCNSL), glioblastoma (GBM) and inflammatory demyelination in magnetic resonance diffusion-weighted imaging (DWI) Value) and its correlation with Ki-67 positive rate. Methods Eighty-seven intracranial PCNSL, GBM and inflammatory demyelination patients were enrolled in the First People’s Hospital of Xianyang from October 2013 to October 2015. The patients were divided into intracranial PCNSL group (40 cases) , GBM group (39 cases) and inflammatory demyelination group (8 cases). The relative apparent diffusion coefficient (rADC) values of each group were analyzed by diffusion weighted imaging (DWI). The expression of Ki-67 in each group was detected by immunohistochemistry, and the relationship between rADC value and Ki- 67 in the correlation between groups. Results The rADC values in patients with intracranial PCNSL were (0.68 ± 0.11) × 10 (-5) m ~ 2 / s lower than those in patients with GBM (0.77 ± 0.05 × 10 ~ (-5) m ~ 2 / s (0.84 ± 0.06) × 10 ~ (-5) m ~ 2 / s in patients with inflammatory demyelination, and the difference was statistically significant (all P <0.05). The positive rates of Ki-67 in intracranial PCNSL group, GBM group and inflammatory demyelination group were 90.0%, 57.5% and 25.0%, respectively. The difference between the two groups was statistically significant (P <0.05). Correlation analysis showed that there was a negative correlation between the rADC values and Ki-67 positive rates in each group, the correlation coefficients were r_ (PCNSL group) = -0.618, r_ (GBM group) = -0.624 and r_ Myelin group) = 0.653. Conclusions The diagnostic value of intracranial PCNSL, GBM and inflammatory demyelination using DWI is of differential value. The rADC value is negatively correlated with the positive rate of Ki-67, providing a noninvasive quantitative indicator for the judgment of the degree of exacerbation.