CT和MRI对高级别胶质瘤和脑转移瘤的鉴别诊断价值

Value of CT and MRI in the Differential Diagnosis of High-grade Glioma and Brain Metastases

目的分析颅脑X线计算机断层扫描(CT)和磁共振成像(MRI)增强扫描对高级别胶质瘤(HGG)和脑转移瘤(BM)的鉴别诊断价值。方法选择经脑活检或手术病理确诊的40例HGG患者和56例BM患者,治疗前均接受颅脑CT与MRI增强扫描,比较HGG和BM的颅脑CT与MRI的定性、定量特征,通过Logistic回归分析获得诊断鉴别HGG、BM的影像学特征,分析其诊断价值。结果HGG与BM在病灶数目、密度、肿瘤形状、肿瘤边界、肿瘤占位、钙化等颅脑CT影像特征方面的差异有统计学意义(P<0.05)。HGG与BM的颅脑MRI定量特征比较结果显示,HGG组肿瘤实质区域各向异性分数(FA)值显著大于BM组(P<0.05),边缘区域FA值、瘤周水肿区域表观扩散系数(ADC)值显著小于BM组(P<0.05)。Logistic回归分析显示颅脑CT中密度、肿瘤形状、肿瘤边界、钙化是鉴别诊断HGG、BM的独立影响因素(P<0.05),颅脑MRI中肿瘤实质区域FA值、边缘区域FA值是鉴别诊断HGG、BM的独立影响因素(P<0.05)。颅脑CT、MRI增强扫描鉴别诊断HGG、BM的曲线下面积(AUC)分别为0.898、0.923。结论颅脑CT和颅脑MRI都可以用于鉴别诊断HGG和BM,但颅脑MRI诊断价值更高。

Objective To analyze the value of brain X-ray computed tomography(CT)and magnetic resonance imaging(MRI)enhancement scan in the differential diagnosis of high-grade glioma(HGG)and brain metastases(BM).Methods A total of 40 patients with HGG and 56 patients with BM confirmed by brain biopsy or surgical pathology were selected.All patients underwent brain CT and MRI enhancement scan before treatment.The qualitative and quantitative characteristics of brain CT and MRI for HGG and BM were compared.The imaging features of HGG and BM were analyzed by logistic regression analysis,and their diagnostic value was analyzed.Results There were statistically significant differences in brain CT characteristics(number of lesions,density,tumor shape,tumor boundary,tumor occupation,and calcification)between HGG and BM(P<0.05).For quantitative characteristics of brain MRI,fractional anisotropy(FA)value of tumor parenchyma area in HGG group was significantly greater than that in BM group(P<0.05).FA of marginal area and apparent diffusion coefficient(ADC)of peritumoral edema area were significantly lower than those in BM group(P<0.05).Logistic regression analysis showed that density,tumor shape,tumor boundary and calcification in brain CT were independent influencing factors in the differential diagnosis of HGG and BM(P<0.05).FA values of tumor parenchyma area and marginal area in brain MRI were independent influencing factors in the differential diagnosis of HGG and BM(P<0.05).The area under the curve(AUC)values of brain CT and MRI enhancement scan in the differential diagnosis of HGG and BM were 0.898 and 0.923,respectively.Conclusion Both brain CT and brain MRI can be used for differential diagnosis of HGG and BM,but the diagnostic performance of brain MRI is better.