瘤周水肿区MinADC值鉴别脑转移瘤和高级别胶质瘤中的阈值及效能探讨

Threshold Value and Efficiency of MinADC Value in Peritumoral Edema Area in Distinguishing Brain Metastases from High-Grade Gliomas

目的探讨瘤周水肿区最小表观扩散系数(MinADC)值鉴别脑转移瘤(BM)和高级别胶质瘤(HGG)中的阈值及效能。方法选定本院2019年1月-2021年1月收诊的56例BM患者与40例HGG患者,按照疾病不同分为A组(BM)与B组(HGG),均行磁共振成像(MRI)增强扫描,同时结合Min ADC值完成诊断。评测两组的强化方式、瘤周水肿、坏死囊变、瘤内出血、肿瘤形态、肿瘤部位,比较两组的Min ADC值,并利用受试者工作特征(ROC)曲线分析该系数值鉴别疾病的最佳截断值(阈值)及效能。结果(1)经MRI增强扫描,A组中发现174个瘤灶,B组中发现44个瘤灶。A组在强化方式、瘤周水肿、坏死囊变、瘤内出血、肿瘤形态上与B组相比,存在明显差异(P<0.05);而在肿瘤部位、平扫例数方面与B组相比,差异不明显(P>0.05)。(2)A组的Min ADC值为(1.49±0.23)×10^(-3)mm^(2)/s,高于B组(1.28±0.15)×10^(-3)mm^(2)/s,(P<0.05)。(3)经ROC曲线分析,两组Min ADC值的ROC曲线下面积为0.957;其阈值为1.355×10^(-3)mm^(2)/S;其特异度、敏感度、约登指数分别为84.1%、93.1%、77.2%。结论采用MRI增强扫描有助于了解患者颅内肿瘤的大小、形态及数目,同时结合瘤周水肿区MinADC值能够有效鉴别BM、HGG,其诊断效能较佳。

Objective To explore the threshold value and efficiency of minimum apparent diffusion coefficient(MinADC)value in peritumoral edema area in distinguishing brain metastases(BM)from high-grade gliomas(HGG).Methods 56 patients with BM and 40 patients with HGG admitted to the hospital were selected between January 2019 and January 2021,and were divided into group A(BM)and group B(HGG)according to the disease types.All the patients underwent magnetic resonance imaging(MRI)enhanced scan and were combined with MinADC value to complete the diagnosis.The enhancement method,peritumoral edema,necrotic cystic degeneration,intratumoral hemorrhage,tumor morphology and tumor location were evaluated and measured in the two groups.The MinADC value of the two groups was compared,and receiver operating characteristic(ROC)curve was adopted to analyze the best cut-off value(threshold value)and efficiency of this coefficient value in identifying the disease.Results(1)After MRI enhanced scan,174 tumor foci were found in group A and 44 tumor foci were found in group B.There were significant differences in the enhancement method,peritumoral edema,necrotic cystic degeneration,intratumoral hemorrhage and tumor morphology in group A compared with those in group B(P<0.05).There were no obvious differences in tumor location and the number of cases with plain scan compared with those in group B(P>0.05).(2)The MinADC value was(1.49±0.23)×10^(-3)mm^(2)/s of group A,which was higher than(1.28±0.15)×10^(-3)mm^(2)/s of group B(P<0.05).(3)After ROC curve analysis,the area under the ROC curve,threshold value,specificity,sensitivity and Youden index of MinADC value were 0.957,1.355×10^(-3)mm^(2)/s,84.1%,93.1% and 77.2% respectively.Conclusion The use of MRI enhanced scan is helpful to understand the size,morphology and quantity of intracranial tumors in patients.The combination of MinADC value in peritumoral edema area can effectively distinguish BM from HGG,and its diagnostic efficiency is better.