CT联合MRI在中枢神经脱髓鞘疾病诊断中的价值分析

Value of CT Combined with MRI in the Diagnosis of Central Nervous System Demyelinating Diseases

目的分析CT、MRI在中枢神经脱髓鞘疾病诊断中的临床价值。方法回顾性分析我院20例拟诊断为中枢神经脱髓鞘疾病患者的临床资料,所有患者均接受CT或(和)MRI检查,并行手术治疗。以手术病理结果为金标准,评价CT、MRI诊断中枢神经脱髓鞘疾病灵敏度、特异度、阳(阴)性预测值和Kappa值,并比较两种成像学方法的影像表现。结果 CT诊断中枢神经脱髓鞘疾病的灵敏度为0.667,特异度为0.500,准确度为0.636,阳性预测值为0.857,阴性预测值为0.250,Kappa值为0.120,CT与手术结果的一致性较差;MRI诊断中枢神经脱髓鞘疾病的灵敏度为0.909,特异度为0.500,准确度为0.846,阳性预测值为0.909,阴性预测值为0.500,Kappa值为0.409,CT与手术结果的一致性一般;CT诊断异常率为63.64%,MRI诊断异常率为84.62%;CT平扫示轻度水肿与占位效应,难以与中枢神经系统肿瘤相鉴别,MRI病变周围水肿较CT显示更为清晰。结论 CT、MRI可对中枢神经脱髓鞘疾病进行有效诊断,且MRI诊断效果优于CT,但对于非典型病例,其影像学表现不具有特征性,应结合临床、病程、病理、实验室检查等多方面进行鉴别。

Objective To analyze the clinical value of CT and MRI in the diagnosis of central nervous system demyelinating diseases. Methods The clinical data of 20 patients with central nervous system demyelinating diseases were analyzed retrospectively. All patients were given CT or(and) MRI. The surgical results were taken as the gold standard to evaluate the sensitivity, specificity, positive(negative) predictive value and Kappa value(consistency) of CT and MRI in diagnosing central nervous system demyelinating diseases, and the imaging results were compared. Results The sensitivity, specificity, accuracy, positive predictive value, negative predictive value and the Kappa value in the diagnosis of central nervous system demyelinating diseases were 0.667, 0.500, 0.636, 0.857, 0.250 and 0.120 by CT, and the consistency between CT and surgical results was poor. The sensitivity, specificity, accuracy, positive predictive value, negative predictive value and the Kappa value in the diagnosis of central nervous system demyelinating diseases were 0.909, 0.500, 0.846, 0.909, 0.500 and 0.409 by MRI, and the consistency of MRI and surgical results was general. The abnormal rate of diagnosis was 63.64% by CT and 84.62% by MRI. CT scan showed mild edema and mass effect, which was difficult to distinguish from central nervous system tumors. The edema around lesions by MRI was clearer than that by CT. Conclusion CT and MRI can effectively diagnose the demyelinating diseases of central nervous system, and the diagnostic effect of MRI is better than that of CT. However, for atypical cases, their imaging manifestations are not characteristic, and they should be differentiated in combination with clinical, course of disease, pathology, laboratory examination and other aspects.