基于磁共振表观扩散系数及对比增强T1WI直方图分析鉴别诊断非典型性畸胎样/横纹肌样肿瘤与髓母细胞瘤

Differential diagnosis of atypical teratoid/rhabdoid tumor from medulloblastoma based on apparent diffusion coefficient and contrast-enhanced T1 weighted imaging histogram analysis

目的探讨基于表观扩散系数(apparent diffusion coefficient,ADC)及对比增强T1WI(contrast-enhanced T1 weighted imaging,CE-T1WI)直方图分析鉴别非典型性畸胎样/横纹肌样肿瘤(atypical teratoid/rhabdoid tumor,AT/RT)与髓母细胞瘤(medulloblastoma,MB)的价值。材料与方法回顾性分析2013年11月至2021年5月就诊于郑州大学第一附属医院经手术组织病理证实的15例AT/RT及20例MB患者资料。记录两组病例的性别、年龄、肿瘤部位、最大径、瘤内囊变、瘤内出血、实质明显强化及最小ADC值情况。采用MaZda软件于ADC及CE-T1WI肿瘤最大层面勾画感兴趣区(region of interest,ROI),行灰度直方图分析,获取9个特征参数。两组间计量资料的比较采用独立样本t检验或Mann-Whitney U检验,分类资料的比较采用Fisher精确检验。通过logistic回归分析对差异有统计学意义的直方图参数进行变量筛选构建综合模型,绘制受试者工作特征(receiver operating characteristic curve,ROC)曲线并计算曲线下面积(area under the curve,AUC)评价各参数及综合模型的鉴别诊断效能。结果两组肿瘤患者在发病年龄及瘤内出血方面存在一定的差异性;在ADC直方图参数中,偏度及第1、10百分位数的差异有统计学意义(P<0.05),AUC分别为0.701、0.778、0.642;在CE-T1WI直方图参数中,方差的差异有统计学意义(P<0.05),AUC为0.743;经logistic回归构建的综合模型,AUC为0.854,敏感度为68.8%,特异度为88.9%。结论基于ADC及CE-T1WI肿瘤最大层面直方图分析获得的定量参数对AT/RT和MB的术前鉴别诊断有一定的价值,为临床治疗方案的选择提供参考依据。

Objective:To explore the value of histogram analysis based on apparent diffusion coefficient(ADC)and contrast-enhanced T1 weighted imaging(CE-T1WI)in differentiating atypical teratoid/rhabdoid tumor(AT/RT)from medulloblastoma(MB).Materials and Methods:A retrospective study includes 15 cases of AT/RT and 20 cases of MB confirmed by surgical histopathology and performed MRI examination from November 2013 to May 2021 in the First Affiliated Hospital of Zhengzhou University.Gender,age,location,maximum diameter,intra-tumoral cystic degeneration,intra-tumoral hemorrhage,obvious parenchymal enhancement and minimum ADC value of the two groups were recorded.MaZda software was used to delineate the region of interest(ROI)on the maximum tumor layer of ADC and CE-T1WI,and perform the gray histogram analysis.Nine histogram parameters were acquired.Independent sample t-test or Mann-Whitney U test was used to compare measurement data between the two groups,and Fisher's exact test was used to compare categorical data.A comprehensive model was established by screening histogram parameters with difference through logistic regression analysis.By drawing receiver operating characteristic(ROC)curve and calculating area under the curve(AUC),the differential diagnosis efficiencies of each parameter and the comprehensive model were evaluated.Results:In ADC,skewness and Pere.01%,Pere.10%had statistically significant differences(P<0.05),and AUC were 0.701,0.778 and 0.642,respectively.In CE-T1WI,variance is statistically significant(P<0.05),and AUC was 0.743.The comprehensive model established by logistic regression analysis showed AUC of 0.854,sensitivity of 68.8%and specificity of 88.9%.Conclusions:The quantitative parameters obtained based on ADC and CE-T1WI histogram analysis of tumor maximum layer have certain value in preoperative differential diagnosis of AT/RT and MB,and provide a reference for the selection of clinical treatment.