动态磁敏感增强MR灌注成像在脑脓肿与坏死或囊变性脑转移瘤和高级胶质瘤鉴别诊断中的价值

Value of dynamic susceptibility contrast MR perfusion-weighted imaging in differential diagnosis of brain abscess from necrotic or cystic metastatic brain tumor and high-grade glioma

目的探讨动态磁敏感增强(dynamic susceptibility contrast,DSC)MR灌注成像在脑脓肿与坏死或囊变性脑转移瘤和高级胶质瘤鉴别诊断中的价值。方法对经手术病理证实的20例包膜期脑脓肿与27例坏死或囊变性脑转移瘤和高级胶质瘤患者,在术前行常规MRI及DSC-MR灌注成像,分析脓肿壁以及瘤体的MR灌注时间-信号曲线以及CBV伪彩图表现,同时测量并计算其平均最大rrCBV值。结果脑脓肿的MR灌注时间-信号曲线与坏死或囊变性脑转移瘤和高级胶质瘤间存在区别,且16例(16/20)脑脓肿与所有27例坏死或囊变性脑转移瘤和高级胶质瘤的CBV伪彩图表现亦存在不同,同时脓肿壁的最大rrCBV值(2.55±0.92)与瘤体(4.32±1.09)比较差异有统计学意义(P<0.01)。结论DSC-MR灌注成像能反映脑脓肿与坏死或囊变性脑转移瘤和高级胶质瘤的差别,在其术前鉴别诊断中具有重要的临床价值。

Objective To explore the value of dynamic susceptibility contrast MR （DSC-MR） perfusion- weighted imaging in differential diagnosis of brain abscess from necrotic or cystic metastatic brain tumor and high-grade glioma. Methods A total of 47 patients （20 patients with abscess and 27 patients with necrotic or cystic metastatic brain tumor and high-grade glioma） confirmed histologically were examined before operation using conventional MRI and DSC-MR perfusion-weighted imaging. The time-signal intensity curves and CBV artificial color mapping were analyzed. The mean maximum rrCBV values of the abscess walls and the bodies of necrotic or cystic metastatic brain tumor and high-grade glioma were measured and calculated. Results Difference was found in the time-signal intensity curves of brain abscess from those of necrotic or cystic metastatic brain tumor and high-grade glioma. Difference was also found in the CBV artificial color mapping in 16 （ 16/ 20） cases of brain abscess from all 27 cases of necrotic or cystic metastatic brain tumor and high-grade glioma. The mean maximum rrCBV value in the walls of the abscess （2.55 ± 0.92） was lower than that in the bodies of the necrotic or cystic metastatic brain tumor and high-grade glioma [ （4.32 ± 1.09）, P 〈0.01 ]. Conclusion DSC-MR perfusion-weighted imaging can reveal the differences and it is of significant clinical value in preoperative differential diagnosis of brain abscess from necrotic or cystic metastatic brain tumor and high-grade glioma.