SWI在胶质母细胞瘤与单发脑转移瘤鉴别中的价值

Value of susceptibility-weighted imaging in differentiative diagnosis of glioblastomas and solitary brain metastases

目的探讨磁敏感加权成像(SWI)鉴别胶质母细胞瘤与单发脑转移瘤的临床价值。方法回顾性分析2014年3月至2017年3月经病理证实的21例胶质母细胞瘤与21例脑转移瘤的影像学资料,比较两种肿瘤SWI指标,包括肿瘤内磁敏感信号(ITSS)评分、肿瘤静脉血管数目、出血个数及出血指数;采用受试者工作特征(ROC)曲线分析各指标鉴别诊断的效能。结果两种肿瘤ITSS评分、出血个数无统计学差异(P>0.05);但是胶质母细胞瘤静脉血管数目明显高于脑转移瘤(P<0.05),出血指数明显低于脑转移瘤(P<0.05)。根据ROC曲线分析,肿瘤静脉血管数目为6.5时,鉴别诊断胶质母细胞瘤和脑转移瘤效能最高,曲线下面积为0.751,灵敏度、特异度分别为0.684、0.789;而出血指数为0.9时,鉴别诊断效能最高,曲线下面积为0.715,灵敏度、特异度分别为0.632、0.947。结论采用SWI可为诊断脑肿瘤提供更多信息,对鉴别胶质母细胞瘤与脑转移瘤具有一定价值。

Objective To explore the optimal indicator and the corresponding diagnostic threshold to differentiate glioblastomas from solitary brain metastases using susceptibility-weighted imaging(SWI).Methods Four indicators of SWI including intratumorous susceptibility signal(ITSS)scores,the number of veins and the number of hemorrhage in the tumorous parenchyma and the bleeding index were derived from 21 patients with cerebral gliobastomas and 21 with solitary brain metastases confirmed pathologically who received routine MRI and SWI examination from March,2014 to March,2017.All the indicators were compared between the glioblastomas and solitary brain metastases,and then the receiver operating characteristic(ROC)curves were constructed to observe the efficiency of differential diagnosis.Results The number of the intratumorous veins was significantly more and the bleeding index were statistically lower in the glioblastomas than those in the metastases(P<0.01).There were insignificant differences in ITSS scores and the number of hemorrhage between the glioblastomas and metastases(P>0.05).The analyses of the number of the intratumorous veins and bleeding index by ROC curve showed that the area under the ROC curve of the number of the intratumorous veins was the highest(0.751)at the cut off value of 6.5,and the sensitivity and specificity were 0.684 and 0.789,respectively.The area under the ROC curve of the bleeding index was 0.715 at the cut off value of 0.9,and the sensitivity and specificity were 0.632 and 0.947 respectively.Conclusion SWI,which can provide the more information of tumors for the diagnosis is of value to differentiation of the glioblastomas from the solitary brain metastases.