MRI鉴别诊断原发性中枢神经系统淋巴瘤与高级别胶质瘤深部病灶

目的探讨MRI鉴别诊断原发性中枢神经系统淋巴瘤(PCNSL)与高级别胶质瘤(HGG)脑深部病灶的价值。方法分析经临床及病理证实的28例PCNSL(PCNSL组)和30例HGG(HGG组)脑深部单发病灶的常规MRI及DWI特征,测量表观扩散系数(ADC)值、相对ADC(rADC)值,根据ROC曲线确定ADC、rADC值的最佳诊断阈值及鉴别诊断PCNSL与HGG的效能。结果 PCNSL组与HGG组的囊变、坏死、出血发生率、增强形态及DWI信号强度差异均有统计学意义(P均0.05)。PCNSL与HGG病灶ADC值与对侧脑白质ADC值差异均有统计学意义(P均0.001);PCNSL组病灶ADC值、rADC值显著低于HGG组(P均0.001)。以ADC=0.86×10~(-3)mm~2/s为界值,鉴别诊断PCNSL与HGG的敏感度、特异度和准确率分别为92.9%、80.0%和86.2%,曲线下面积为0.946(P0.001);以rADC=1.02为界值,鉴别诊断PCNSL与HGG敏感度为92.9%,特异度为86.7%,准确率为89.7%,曲线下面积为0.957(P0.001)。结论 MRI可鉴别诊断PCNSL与HGG,为临床治疗提供可靠依据。

MRI in differential diagnosis of primary central nervous system lymphoma and high grade glioma in deep brain

Objective To explore the value of MRI in differential diagnosis of primary central nervous system lymphoma (PCNSL) and high grade glioma (HGG) in deep brain.Methods Features of routine MRI and DWI of 28 PCNSL (PCNSL group) and 30 HGG patients (HGG group) with single lesion in deep brain confirmed clinically and pathologically were analyzed, then apparent diffusion coefficient (ADC) and relative ADC (rADC) were measured. The optimal diagnostic threshold (OT) and diagnostic performance of ADC and rADC values were calculated according to the ROC curve.Results The incidence of capsule, necrosis, hemorrhage, enhancement heterogeneity and DWI signal strength were significantly different between the two groups (all P<0.05). ADC values were statistically different between lesions and the control side of the brain white matter in PCNSL and HGG patients (both P<0.001). ADC values and rADC values of PCNSL lesions were significantly lower than those of HGG lesions (all P<0.001). Taking ADC=0.86×10^-3 mm²/s as a threshold, the sensitivity, specificity and accuracy in differential diagnosis of PCNSL and HGG was 92.9%,80.0% and 86.2%, respectively, and the area under curve was 0.946(P<0.001). Taking rADC=1.02 as a threshold, the sensitivity, specificity and accuracy in differential diagnosis of PCNSL and HGG was 92.9%, 86.7% and 89.7%, respectively, and the area under curve was 0.957 (P<0.001).Conclusion MRI differential diagnosis can provide reliable information for clinical treatment of PCNSL and HGG in deep brain.