扩散峰度成像鉴别诊断高级别胶质瘤与脑转移瘤的临床价值

目的 探讨扩散峰度成像（DKI）鉴别诊断高级别胶质瘤（HGG）和单发脑转移瘤（BM）的临床应用价值。方法 回顾性分析2017年3月至2018年12月收治的23例HGG和19例单发BM的临床资料。所有病人均行MRI扫描及DKI扫描，分析两类肿瘤实质区和瘤周区DKI参数各向异性分数（FA）、平均扩散（MD）及平均峰度（MK）。利用ROC曲线计算敏感度、特异度及曲线下面积（AUC）。结果 HGG和单发BM病人MRI增强均显示不规则环状强化灶。HGG和单发BM实质区DKI参数FA、MD及MK值均无统计学差异（P>0.05）。与单发BM瘤周区相比，HGG瘤周区DKI参数FA和MK值更高（P<0.05），MD值更低（P<0.05）。与DKI参数FA和MD值相比，瘤周区MK值鉴别HGG和单发BM的特异性与灵敏度更高，AUC更大。结论 瘤周区DKI参数FA、MD及MK值在HGG和单发BM鉴别诊断中具有重要的临床价值，且瘤周区MK值的诊断效能更高。

Value of diffusion peak imaging to differential diagnosis of WHO high-grade gliomas and solitary brain metastases

Objective To investigate the clinical value of diffusion kurtosis imaging (DKI) in differential diagnosis of WHO high grade gliomas (HGG) and solitary brain metastases (SBM). Methods MRI scan and DKI scan were performed in 23 patients with WHO HGG and 19 patients with SBM. The anisotropy fraction (FA), mean diffusion (MD) and mean kurtosis (MK) of tumorous parenchyma and peritumorous area were analyzed and compared between both the groups. The sensitivity, specificity and area under curve (AUC) were calculated by receiver operating characteristic curve. Results There were no significant differences in FA, MD and MK of the parenchymas between HGG and SBM (P>0.05). The values of FA and MK were significantly higher and the value of MD was significantly lower in the peritumorous area of HGG than those in the peritumorous area of SBM (P<0.05). The specificity and sensitivity of MK in the peritumorous area to the differential diagnosis of HGG and SBM were significantly higher, and its AUC was significantly larger than those of FA and MD. Conclusions The FA, MD and MK in the peritumorous area have important clinical value to the differential diagnosis of HGG and SBM, and the value of MK in the peritumorous area to the differential diagnosis of HGG and SBM is more higher than those of FA and MD.