MRI弥散加权成像ADC值在鉴别结节性硬化患儿颅内病变的作用

The role of AD value in MRI diffusion-weiglted imaging in the differentitation of intracramial lessions in children with tulerous scleroisis

目的 探讨MRI弥散加权成像ADC值在鉴别结节性硬化患儿颅内病变性质中的作用。方法 收集我院2017年1月~2018年1月经手术或活检明确诊断为结节性硬化同时术前行MRI检查患者32例,其中男性18例,女性14例,年龄18个月~17岁。依据病理结果分析对应病变的MRI影像表现,并测量各病变在DWI序列中的ADC值,探讨ADC值在颅内不同病变中的诊断价值及其与病理分型间的相关性。结果 32例患者中,24例出现室管膜下多发结节(75.0%),室管膜下结节多呈稍短T1WI稍长T2WI信号,边界清晰,部分呈等信号,DWI序列可见部分结节呈高信号,ADC值减低,室管膜下结节往往大小不一,部分凸向侧脑室内,导致侧脑室积水、扩张。另外有14例患者出现皮层或皮层下结节影,T1WI呈稍低信号,T2WI呈稍高信号,边界常常欠清,T2WIFLAIR序列大部分呈高信号,DWI序列可呈高信号。共计取得术后或活检病理结果的病理总数为76个,其中为星形细胞胶质瘤的病灶有24个(31.58%),单纯室管膜下结节有51个(67.11%),其它病变1个(1.32%)。对各病变测量ADC值后发现:星形胶质瘤病灶的ADC值约为(56.78±8.38)×10^-6mm^-2/s,而单纯室管膜下结节的ADC值约为(87.49±7.94)×10^-6mm^-2/s,两者间差异有统计学意义(t=5.977,P=0.012<0.05)。结论 MRI弥散加权成像ADC值能够有效的在术前鉴别结节性硬化患者颅内病变性质,其中胶质瘤病变的ADC值要显著低于单纯室管膜下结节。

Objective To investigate the role of ADC in diffusion-weighted imaging (MRI) in differentiating intracranial lesions from tuberous sclerosis. Methods 32 cases of nodular sclerosis were diagnosed as nodular sclerosis in our hospital from January 2017 to 2018, including 18 men, 14 women. According to the pathological results, the MRI images of the corresponding lesions were analyzed, and the ADC values in the DWI sequences were measured, and the diagnostic value of ADC in different intracranial lesions and the correlation between the pathological changes and the pathological types were discussed. Results 24 of them had subependyma multiple nodules (75%). The subependymal nodules were slightly short T 1WI and slightly long T 2WI signals, with clear boundaries and partial signals. The DWI sequence showed that the partial nodules were high signal, the ADC value was reduced, the subventricular nodules were often different in size, and partly convex to the lateral ventricle. It causesd the lateral ventricle to accumulate and dilate. In addition, there were 14 cases of subcortical or subcortical nodules, with a slightly longer T 1WI and slightly longer T 2WI signal, the boundary was often unclear, most of the T 2WI FLAIR sequence was high signal, and the DWI sequence could be high signal. The total number of pathological results obtained after surgery or biopsy was 76, of which 24(31.58%) were the lesions of astrocytoma, 51(67.11%) and 1(1.32%) for the simple ependymal nodules. After measuring the ADC values of the lesions, the ADC value of the astrocytoma was about (56.78±8.38)×10 ^-6 mm ^-2 /s, while the ADC value of the simple ependymal nodules was (87.49±7.94)×10^-6 mm^-2 /s, and the difference was statistically significant ( t =5.977, P =0.012 < 0.05). Conclusion The ADC value of MRI diffusion weighted imaging can effectively identify the properties of intracranial lesions in patients with nodular sclerosis, and the ADC value of glioma lesions is significantly lower than that of the simple ependymal nodules.