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目的:分析脑实质结核的MRI特点,探讨多b值弥散加权成像(DWI)对脑实质结核与脑转移瘤鉴别诊断的应用价值。方法:对28例脑实质结核和31例脑转移瘤患者行MRI检查和多b值DWI成像,分析两者的MRI表现,测量实性强化病灶及环形强化病灶的强化环壁、中央坏死的各类表观扩散系数(apparent diffusion coefficient,ADC)值,包括ADC_(10b)、ADC_(high)及ADC_(perf)值,采用两样本t检验。结果:脑实质结核337个病灶,实性均匀强化病灶102个,69.6%≤3.0mm,25.5%在3.0~10.0mm之间;环形强化病灶235个,环壁厚薄均匀光整,32.4%在3.5~5.0mm之间,45.5%在5.0~10.0mm之间,22.1%≥10.0mm。脑转移瘤285个,实性欠均匀强化病灶74个,27.0%≤3.0mm,73.0%>3.0mm;环形强化病灶211个,环壁凹凸不平,84.8%>5.0mm。脑实质结核中实性强化结节、强化环壁的ADC_(high)值分别为(0.240±0.038)×10~(-3)mm~2/s、(0.249±0.039)×10~(-3)mm~2/s,均高于脑转移瘤,脑实质结核环形强化病灶干酪实性中心区的ADC_(high)值为(0.251±0.056)×10~(-3)mm~2/s,低于脑转移瘤的中心坏死区。环形强化病灶中环壁的ADC_(10b)及ADC_(high)值分别以0.088×10~(-3)mm~2/s和0.241×10~(-3)mm~2/s为界,鉴别脑实质结核与脑转移瘤的灵敏度分别为83.9%、58.9%,特异度分别为72.5%、100%。结论:结合病灶大小、MRI强化方式及ADC_(high)值与ADC_(10b)值的测量有利于脑实质结核和脑转移瘤的鉴别诊断。
Objective: To analyze the MRI features of brain parenchymal tuberculosis and explore the value of multi-b-value diffusion-weighted imaging (DWI) in the differential diagnosis of parenchymal tuberculosis and brain metastases. Methods: Twenty-eight patients with brain parenchymal tuberculosis and 31 patients with brain metastases underwent MRI examination and multi-b-value DWI imaging. The MRI findings of the two groups were analyzed. The difference between enhanced solidified lesion and enhanced annular lesion, Apparent diffusion coefficient (ADC) values, including ADC_ (10b), ADC_ (high) and ADC_ (perf) values, were compared using two-sample t-test. Results: There were 337 lesions of parenchymal tuberculosis with 102 solid enhancement lesions, 69.6% ≤3.0 mm and 25.5% between 3.0 and 10.0 mm. There were 235 annular enhancement lesions with a uniform annular thickness and 32.4% at 3.5 ~ 5.0mm, 45.5% between 5.0 ~ 10.0mm, 22.1% ≥ 10.0mm. There were 285 metastatic brain tumors, 74 solidified under-uniform lesions, 27.0% ≤3.0 mm and 73.0%> 3.0 mm respectively. There were 211 annular enhancement lesions, and the annular wall was uneven with 84.8%> 5.0 mm. The ADC_ (high) values of the solidified nodules in the parenchyma of the substantia nigra in the brain were (0.240 ± 0.038) × 10 -3 mm 2 / s and (0.249 ± 0.039) × 10 -3 ) mm ~ 2 / s, which were higher than that of brain metastases. ADC_ (high) value of the solid core of annular enhancement lesions of brain parenchyma was (0.251 ± 0.056) × 10 -3 mm 2 / Lower than the central necrosis area of brain metastases. The values of ADC_ (10b) and ADC_ (high) in the ring wall of central lesion were 0.088 × 10 ~ (-3) mm ~ 2 / s and 0.241 × 10 ~ (-3) mm ~ 2 / The sensitivities of tuberculosis and brain metastases were 83.9%, 58.9% and 72.5%, 100% respectively. Conclusion: The combination of lesion size, MRI enhancement mode, ADC high value and ADC 10b value are helpful for the differential diagnosis of brain parenchymal tuberculosis and brain metastases.