MRI鉴别诊断中枢神经系统孤立性纤维瘤的特征及临床意义

Characteristics and clinical significance of MRI in differential diagnosis of solitary fibroma of central nervous system

目的探究MRI鉴别诊断中枢神经系统孤立性纤维瘤的特征及临床意义。方法选择2014年1月至2020年10月接收的50例疑似中枢神经系统孤立性纤维瘤患者作为研究对象,所有患者均接受MRI、CT以及病理检查,对其检查结果进行回顾性分析。以病理检查结果为金标准,比较MRI、CT检查对中枢神经系统孤立性纤维瘤的诊断效能。结果50例疑似中枢神经系统孤立性纤维瘤患者中,病理检查显示7例患者确诊存在中枢神经系统孤立性纤维瘤。MRI检查共检出6例患者中枢神经系统孤立性纤维瘤,其中4例颅内肿瘤,2例为椎管内肿瘤;颅内肿瘤直径为2.8~6.4 cm,平均直径(3.65±0.57)cm;椎管内肿瘤直径分别为1.8、3.0 cm;患者的肿瘤病灶均边界清晰;DWI显示2例存在稍高信号,2例存在等信号,2例存在稍低信号。4例颅内肿瘤患者中,2例存在轻中度水肿,1例患者周围水肿较为广泛,1例患者未出现水肿;MRI增强扫描均显示患者的病灶明显强化,3例不均匀强化,1例均匀强化;3例邻近骨质出现破坏或增生情况,1例存在脑膜尾征。2例椎管内肿瘤患者中,1例为等T_(1)信号、T_(2)稍长信号,1例为稍长T_(1)信号、等T_(2)信号;增强扫描均显示明显的均匀强化,均未出现脊膜尾征。CT检查显示3例患者存在中枢神经系统孤立性纤维瘤,平扫检查显示主要为高密度,且密度不均匀,内部存在不规则的等密度影,增强扫描显示病灶的密度均匀强化明显。MRI诊断中枢神经系统孤立性纤维瘤的灵敏度、阳性预测值均高于CT检查,差异具有统计学意义(P<0.05)。结论MRI在中枢神经系统孤立性纤维瘤患者鉴别诊断中的应用价值较高,可更准确地检出病例,为患者疾病治疗方案的制定提供参考依据,以改善预后,值得推广应用。

Objective To explore the characteristics and clinical significance of MRI in differential diagnosis of solitary fibroma of central nervous system.Methods Fifty patients with suspected solitary fibroma of central nervous system received from January 2014 to October 2020 were selected as the research objects.All patients underwent MRI,CT and pathological examination,and the examination results were analyzed retrospectively.Taking the results of pathological examination as the gold standard,the efficacy of MRI and CT in the diagnosis of solitary fibroma of central nervous system was compared.Results Among 50 patients with suspected central nervous system solitary fibroma,pathological examination showed that 7 patients were diagnosed with central nervous system solitary fibroma.A total of 6 patients with central nervous system solitary fibroma were detected by MRI,of which 4 cases were intracranial tumors and 2 cases were intraspinal tumors;the diameter of intracranial tumors was 2.8-6.4 cm,with an average diameter of(3.65±0.57)cm;the diameters of the tumors in the spinal canal were 1.8 cm and 3.0 cm,respectively.The tumor lesions of the patients were all well-defined;DWI showed that 2 cases had slightly high signal,2 cases had equal signal,and 2 cases had slightly low signal.Among the 4 patients with intracranial tumors,2 patients had mild to moderate edema,1 patient had extensive peripheral edema,and 1 patient had no edema;enhanced MRI scans showed that the patient's lesions were significantly enhanced,in which 3 patients had uneven enhancement and 1 patient uniform enhancement;3 cases of adjacent bones showed damage or hyperplasia,and 1 case had meningeal tail sign.Among the 2 patients with intraspinal tumors,1 case had equal T_(1) signal and slightly longer T_(2) signal,and 1 case had slightly longer T_(1) signal and equal T_(2) signal;enhanced scan showed obvious uniform enhancement,and there was no meningeal tail sign.CT examination showed that 3 patients had solitary fibroma of the central nervous system.The plain scan showed that it was mainly high-density and uneven density.There were irregular isostensive shadows inside.The enhanced scan showed that the density of the lesions was uniform and enhanced.The sensitivity and positive predictive value of MRI in diagnosing solitary fibroma of central nervous system were higher than those of CT examination,and the differences were statistically significant(P<0.05).Conclusion MRI has high application value in the differential diagnosis of patients with solitary fibroma of central nervous system.It can detect cases more accurately,so as to provide reference basis for the formulation of disease treatment plan and improve the prognosis,which is worthy of popularization and application.