联合增强T1WI和增强SWI在肺癌脑转移诊断的应用价值

Combination of Contrast⁃enhanced T1⁃weighted Imaging and Contrast⁃enhanced Susceptibility⁃weighted Imaging Provides an Efficient Way in Detection of Brain Metastases of Lung Cancer

目的:探讨对比增强T1WI(CE-T1WI)、对比增强磁敏感加权成像(CE-SWI)及二者联合在肺癌脑转移中的诊断效能。方法:纳入怀疑肺癌脑转移的149例患者,均行常规MRI增强扫描、增强SWI扫描。标记异常强化/信号灶,计算检出数目、部位、大小,对患者于3~6个月内随访验证。采用McNemar’s检验统计CE-T1WI和CE-SWI组间的转移瘤检出率差异;采用受试者工作特征(ROC)曲线分析CE-T1WI、CESWI及二者联合的诊断效能。结果:共发现739个异常强化/信号灶,其中转移瘤670个,非转移瘤69个。CE-T1WI组在脑表浅区、颅底区的转移瘤检出率优于CE-SWI组;CE-SWI组在脑深部区、病灶≤5 mm时的转移瘤检出率优于CE-T1WI组。3组(CE-T1WI、CE-SWI及二者联合)的ROC曲线下面积分别为0.738、0.851和0.923。二者联合的诊断效能优于CE-T1WI(P<0.0001)、CE-SWI(P<0.0001)。结论:CE-T1WI和CE-SWI联合是一种有效的肺癌脑转移诊断方法。

Purpose:To investigate the diagnostic confidence of contrast-enhanced T1-weighted imaging(CE-T1WI),contrast-enhanced susceptibility-weighted imaging(CE-SWI)and their combination in the evaluation of brain metastases of lung cancers.Methods:In 149 patients with known lung cancers and suspected cranial metastases,susceptibility-weighted imaging was performed after routine contrast-enhanced MRI examination.Two radiologists reviewed and marked abnormal contrast enhancements or intensity signals on CE-T1WI and CE-SWI,and recorded the numbers,locations and sizes.McNemar's test was used to analyze the differences between CE-T1WI and CE-SWI on the detection rates of brain metastases.And areas under receiver operating characteristic(ROC)curve were calculated in three groups:CE-T1WI,CE-SWI and their combination.Results:Seven hundred and thirty-nine abnormal contrast enhancements/intensity signals were detected,in which 670 were metastatic and 69 were non-metastatic.CE-T1WI was superior to CE-SWI in detection rates of metastases from superficial and basal areas,while CE-SWI was superior to CE-T1WI in detection rates of metastases from deep areas or less than 5 mm.Areas under ROC curve of CE-T1WI,CE-SWI and their combination were 0.738,0.851 and 0.923,respectively.Combination of CE-T1WI and CE-SWI was significantly better in diagnostic efficiency of brain metastases than CE-T1WI(P<0.0001)or CE-SWI(P<0.0001)alone.Conclusion:Combination of CE-T1WI and CE-SWI promotes diagnostic performance and results in better observation and characterization of brain metastases from lung cancers.It provides a valuable way in detecting brain metastases of lung cancers.