Department of Diagnostic Radiology, Ajou University School of Medicine, Suwon, Korea.
Br J Radiol. 2010 Jun;83(990):466-75. doi: 10.1259/bjr/34304111. Epub 2009 Aug 18.
The purpose of this study was to determine the benefit of high-resolution susceptibility-weighted imaging and the apparent diffusion coefficient for brain tumour imaging, and to assess the clinical feasibility of using a non-contrast MR protocol at 3 T. 73 patients with intra-axial tumours were enrolled into the study. Two experienced neuroradiologists reviewed three MRI sessions: (i) a non-contrast protocol including high-resolution susceptibility-weighted images and apparent diffusion coefficient; (ii) a contrast protocol including MR perfusion images; and (iii) combined contrast and non-contrast protocols. The two observers categorised tumours as glial or non-glial tumours, and then subcategorised the gliomas into low-grade or high-grade tumours. For semi-quantitative analysis, a scoring system based on the degree of intra-tumoral susceptibility signals and the visual apparent diffusion coefficient was used. The two observers diagnosed accurate tumour pathology in 52 (71%) of 73 tumours in the first review, 55 (75%) of 73 tumours in the second review and 61 (84%) of 73 tumours in the third review. The addition of the non-contrast protocol to the contrast protocol significantly differentiated glioblastoma multiforme and metastatic tumours, which was not possible with the contrast protocol alone. The sensitivity, specificity, positive predictive value and negative predictive value for glioma grading with the non-contrast protocol were 83.2%, 100%, 100% and 79.3%, respectively. The addition of both high-resolution susceptibility-weighted imaging and the apparent diffusion coefficient improved the diagnostic performance of the contrast MR protocol for brain tumour imaging and could be feasible in selected patients who cannot tolerate a contrast agent.
本研究旨在确定高分辨率磁敏感加权成像和表观扩散系数在脑肿瘤成像中的益处，并评估在 3T 下使用非对比磁共振方案的临床可行性。共纳入 73 例颅内肿瘤患者。两位有经验的神经放射科医生对 3 个 MRI 检查进行了评估：（i）包括高分辨率磁敏感加权成像和表观扩散系数的非对比方案；（ii）包括磁共振灌注成像的对比方案；以及（iii）联合对比和非对比方案。两位观察者将肿瘤分类为胶质或非胶质肿瘤，然后将胶质瘤分为低级别或高级别肿瘤。进行半定量分析时，采用基于肿瘤内磁敏感信号程度和视觉表观扩散系数的评分系统。在第一次评估中，两位观察者正确诊断了 52 个（71%）肿瘤的准确肿瘤病理，在第二次评估中诊断了 55 个（75%）肿瘤的准确病理，在第三次评估中诊断了 61 个（84%）肿瘤的准确病理。与仅使用对比方案相比，将非对比方案添加到对比方案中可显著区分胶质母细胞瘤和转移性肿瘤。非对比方案诊断胶质瘤分级的敏感性、特异性、阳性预测值和阴性预测值分别为 83.2%、100%、100%和 79.3%。高分辨率磁敏感加权成像和表观扩散系数的联合应用提高了对比 MR 方案在脑肿瘤成像中的诊断性能，对于不能耐受造影剂的特定患者可能是可行的。
