DCE-MRI鉴别单发IDH1野生型胶质母细胞瘤、原发性中枢神经系统淋巴瘤及转移瘤的临床价值

Value of dynamic contrast-enhanced MRI in discriminating isocitrate dehydrogenase 1 wildtype glioblastoma, primary central nervous system lymphoma and metastasis

目的应用DCE-MRI评估单发IDH1野生型胶质母细胞瘤、PCNSL及转移瘤的微血管通透性,进一步探讨DCE-MRI鉴别这三种肿瘤的临床价值。方法收集80例病理确诊的脑肿瘤患者,其中IDH1野生型胶质母细胞瘤46例、PCNSL 16例、单发转移瘤18例。所有患者在术前进行DCE-MRI检查,获得Ktrans、Ve的最大值,并对其进行统计分析。P<0.05为差异有统计学意义。结果PCNSL的Ktrans、Ve值高于IDH1野生型胶质母细胞瘤及单发转移瘤,差异有统计学意义。当Ktrans=0.14 minKtrans(-1)、Ve=0.33时,鉴别PCNSL与IDH1野生型胶质母细胞瘤的灵敏度分别为80.4%、71.7%,特异度分别为93.8%、75.0%。当Ktrans=0.10 min^-1、Ve=0.20时,鉴别PCNSL与单发转移瘤的灵敏度分别为77.8%、72.2%,特异度分别为100%、93.8%。结论DCE-MRI可以定量评估IDH1野生型胶质母细胞瘤、PCNSL及单发转移瘤的微血管通透性,并可以无创性鉴别PCNSL与IDH1野生型胶质母细胞瘤或单发转移瘤。

Objective To investigate the image parameters derived from dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)for assessing the microvascular permeability of isocitrate dehydrogenase 1 wildtype(IDH1 wildtype)glioblastoma,primary central nervous system(CNS)lymphoma and metastasis in order to differentiate these tumors.Methods Eighty patients with pathologically confirmed IDH1 wildtype glioblastoma(46),primary CNS lymphoma(16)and solitary metastasis(18)underwent DCEMRI before surgery.The maximal Ktrans and Ve were measured in each tumor and compared.Results Ktrans and Ve were significantly higher in primary CNS lymphoma than that of IDH1 wildtype glioblastoma and solitary metastatic tumor.For differentiating lymphoma from glioblastoma,the cutoff Ktrans values of 0.14 min^-1 and Ve cutoff value of 0.33 resulted in the best combination of sensitivity(80.4%,71.7%)and specificity(93.8%,75.0%).The Ktrans cutoff value of 0.10 min^-1 and Ve cutoff value of 0.20 for differentiating lymphoma from solitary metastasis showed the best combination of sensitivity(77.8%,72.2%)and specificity(100%,93.8%).Conclusion The DCE-MRI can assess the microvascular permeability of IDH1 wildtype glioblastoma,primary CNS lymphoma and solitary metastasis.DCE-MRI can noninvasively discriminate lymphoma from IDH1 wildtype glioblastoma or solitary metastasis.