MRI征象及ADC值鉴别成人颅内髓母细胞瘤与室管膜瘤的价值

Differentiating adult intracranial medulloblastoma and ependymoma using MRI signs and ADC

目的:探索磁共振成像(MRI)征象及表观扩散系数(ADC)值在鉴别成人颅内髓母细胞瘤与室管膜瘤中的价值。方法:回顾性分析手术及病理证实的16例成人颅内髓母细胞瘤及24例室管膜瘤临床、MRI及病理资料,对比MRI征象及ADC值差异,使用受试者工作特征(ROC)曲线评估ADC值在两组肿瘤鉴别诊断中的效能。结果:成人髓母细胞瘤与室管膜瘤在年龄、肿瘤位置和强化程度比较差异有统计学意义(P<0.05),两组患者性别、形态、肿瘤边界、囊变、瘤周水肿、肿瘤最大径、水肿最大径等比较差异无统计学意义(P>0.05);成人室管膜瘤ADC_(mean)、ADC_(min)及rADC值均大于成人髓母细胞瘤,差异有统计学意义(P<0.05)。ADC_(mean)阈值为665.00 mm^(2)/s时,鉴别诊断成人髓母细胞瘤与室管膜瘤的性能最佳,AUC值为0.966,敏感度和特异度分别为0.958、0.937。结论:通过MRI征象联合ADC值对术前鉴别成人髓母细胞瘤与室管膜瘤具有重要的临床价值,有助于辅助临床术前制定个性化诊疗方案。

Objective To explore the value of MRI signs and apparent diffusion coefficient(ADC)in differentiating adult intracranial medulloblastoma from ependymoma.Methods The clinical,MRI and pathological data of 16 adults with intracranial medulloblastoma and 24 with ependymoma confirmed by surgery and pathology were retrospectively analyzed.The differences between two groups in MRI signs andADC values were compared,and receiver operating characteristic curve was used to assess the diagnostic efficacy ofADC values in the differentiation of adult intracranial medulloblastoma and ependymoma.Results There were statistically significant differences between adult medulloblastoma and ependymoma in age,tumor location and degree of enhancement(P<0.05),but not in gender,morphology,tumor boundary,cystic degeneration,peritumoral edema,maximum diameter of the tumor,and maximum diameter of edema(P>0.05).TheADC_(mean),ADC_(min) and rADC values of adult ependymoma were greater than those of adult medulloblastoma,and the differences were statistically significant(P<0.05).When the ADC_(mean) threshold was 665.00 mm^(2)/s,it had the best performance for the differential diagnosis of adult medulloblastoma and ependymoma,with anAUC of 0.966,and its sensitivity and specificity were 0.958 and 0.937,respectively.Conclusion The combination of MRI signs and ADC has important clinical value for the preoperative differentiation of adult medulloblastoma and ependymoma,and it is helpful to assist the formulation of preoperative personalized diagnosis and treatment scheme.