磁共振扩散加权成像在肾细胞癌脑转移诊断中的应用

The application of MR diffusion weighted imaging in the diagnosis of renal cell carcinoma with brain metastasis

目的:探讨磁共振扩散加权成像(MRI DWI)在肾细胞癌(RCC)脑转移诊断中的应用价值。方法:采用回顾性研究方法分析2014年2月至2016年5月在我院诊治的140例RCC患者,所有患者都给予常规MRI T1WI与T2WI序列诊断,同时给予DWI序列的ADC值测定与诊断价值判定。结果:所有患者的MRI图像均显示清晰,病理确诊为RCC脑转移40例,RCC 100例。39例RCC脑转移患者的T2WI序列表现为高信号,36例T1WI序列表现为高信号;78例RCC患者的T2WI序列表现为高信号,72例T1WI序列表现为高信号,对比差异都有统计学意义(P<0.05)。140例患者肾实质ADC值是(2.21±0.32)×10-3mm2/s,同时,患者肾脏实性肿瘤ADC值是(1.54±0.37)×10-3mm2/s,对比差异有统计学意义(t=4.298,P<0.05);RCC患者的ADC值为(1.26±0.21)×10-3mm2/s,RCC脑转移患者的ADC值为(1.59±0.30)×10-3mm2/s,RCC脑转移的ADC值明显高于RCC患者(P<0.05)。将阈值设定为1.355×10-3mm2/s,通过DWI对RCC患者的脑转移进行诊断,得出其特异性为92.1%,敏感性为85.0%。结论:在诊断RCC患者的脑转移时,ADC值和DWI可以提供重要依据,两者有很好的应用价值。

Objective： To evaluate the value of MR diffusion weighted imaging（ DWI MRI） in the diagnosis of renal cell carcinoma（ RCC） with brain metastasis. Methods： Used a retrospective study,from February 2014 to May2016,140 patients with RCC in our hospital were as the research object,all patients were given conventional MRI T1WI and T2WI sequence diagnosis,and were given the DWI sequence diagnosis and ADC value determination and diagnosis value judgment. Results： All patients with MRI images were clear,there were 40 patients with RCC with brain metastasis were and 100 patient with RCC by the pathological diagnosis. 39 brain metastases in patients with T2WI sequence showed high signal,36 patients were showed high signal T1WI sequence in the RCC with brain metastasis patients,and there were 78 patients with T2WI sequence showed high signal and 72 patients were showed high signal T1WI sequence in the RCC patients,that compared difference were statistically significant（ P〈0. 05）. 140 patients with renal parenchymal ADC values were（ 2. 21 ± 0. 32） × 10^（-3） mm^2/s,the renal tumor ADC values were（ 1. 54 ± 0. 37） × 10^（-3） mm^2/s that compared was statistically significant difference（ t = 4. 298,P〈0. 05）. The ADC value for the patients with RCC were（ 1. 26 ± 0. 21） × 10^（-3） mm^2/s,and the RCC with brain metastases were（ 1. 59± 0. 30） × 10-3 mm^2/s that compared was statistically significant difference（ P〈0. 05）. The sensitivity and specificity of DWI in the diagnosis of RCC were 85% and 92. 1%,respectively with 1. 355 × 10^（-3） mm^2/s as the threshold.Conclusion： The DWI ADC can provide valuable clinical diagnosis and differentiation for clinical diagnosis of RCC with brain metastasis,and it has good application values.