MRI影像学参数预测血管外皮细胞瘤与血管瘤型脑膜瘤的临床价值

Clinical value of MRI features predicting hemangiopericytoma and angiomatous meningioma

目的探讨MRI影像学参数对预测血管外皮细胞瘤（HPC）和血管瘤型脑膜瘤的临床价值。方法回顾性分析2005年1月至2014年12月南方医科大学南方医院神经外科收治的12例HPC与17例血管瘤型脑膜瘤，病理学诊断以WHO2007分级标准进行。术前MRI参数包括：肿瘤部位、大小、形态、T1加权像、T2加权像、T1增强像、表观弥散系数（ADC）值、液体衰减反转恢复序列（FLAIR）像、瘤周水肿、脑膜尾征、血管流空影、T2加权像中蛛网膜间隙、瘤内出血或坏死。通过单因素分析检验两种类型肿瘤的影像学特征与临床病理之间的关系，采用Logistic回归模型评估这些参数与HPC的关系。结果单因素分析结果表明，两种类型肿瘤的年龄、性别、ADC值、肿瘤坏死和T1增强像之间的差异均有统计学意义（P〈0．05）。Logistic回归模型分析表明，ADC值是HPC唯一的独立预测因素（P=0．039，OR：14．5，95％CI：3．7～38．6）。结论ADC值可作为一个简单有效的工具来鉴别原发性颅内I-IPC和血管瘤型脑膜瘤，术前DWI低信号、ADC值系数高的患者罹患HPC的可能性更大。

Objective To investigate the clinical value of preoperative MRI features for predicting hemangiopericytoma （HPC） and angiomatous meningioma. Methods From January 2005 to December 2014, 12 patients with HPC and 17 with angiomatous meningioma admitted to the Department of Neurosurgery, Nanfang Hospital, Southern Medical University were analyzed retrospectively, and pathological diagnosis was conducted according to the WHO 2307 grading criteria. Preoperative MRI parameters included tumor location, tumor size, tumor shape, Tl-weighted imaging, T2-weighted imaging, Tl-enhanced imaging, apparent diffusion coefficient （ADC） value, fluid-attenuated inversion recovery （FLAIR） imaging, periturnoral edema, dural tail sign, vascular flow void shadow, subarachnoid space in T2-weighted imaging, and tumor hemorrhage or necrosis. The relationship between the two types of tumor imaging features and clinical pathology were detected by using univariate analysis. Logistic regression model was used to evaluate the relationship between these paranleters and HPC. Results The results of univariate analysis showed that there were significant differences between age, gender, ADC value, tumor necrosis of two types of tumors and Tl-enhanced imaging （P 〈0.05）. Logistic regression model demonstrated that the ADC value was the only independent predictor of HPC （P = 0.039, OR： 14. 5, 95% CI：3. 7 - 38. 6）. Conclusions ADC value can be used as a simple and effective tool to identify primary intracranial HPC and angiomatous meningioma. The possibility of HPC in patients with preoperative DWI hypointensity and high ADC coefficient is greater