Kadota Yoshihito, Hirai Toshinori, Nakamura Hideo, Makino Keishi, Yano Shigetoshi, Nishimura Shinichiro, Tateishi Machiko, Azuma Minako, Kitajima Mika, Yamashita Yasuyuki
Department of Radiology, Faculty of Medicine, University of Miyazaki.
Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University.
Magn Reson Med Sci. 2017 Jul 10;16(3):217-222. doi: 10.2463/mrms.mp.2016-0072. Epub 2016 Oct 11.
We aimed to determine whether 3T diffusion-weighted imaging (DWI) has an additive value relative to contrast-enhanced MR imaging for the detection of disseminated lesions in patients with primary malignant brain tumors.
We included consecutive 12 patients with nodular disseminated lesions of primary malignant brain tumors that were confirmed by surgery or follow-up MR imaging. All underwent conventional MR imaging, DWI at b = 1000 and 3000 s/mm, post-contrast T-weighted and 3D gradient-echo imaging at 3T. For the largest lesion per person, two radiologists independently evaluated the presence of additional information on DWI compared with postcontrast MR images using a 4-point scoring system. On DW images, one radiologist measured the lesion-to-brain contrast ratio (LBCR).
Compared with postcontrast studies, radiologists 1 and 2, respectively, assigned more apparent lesion conspicuity in 2 (17%) and 1 (8%) DWI at b = 1000 s/mm and 4 (33%) and 5 (42%) DWI at b = 3000 s/mm studies. For one of them, the mean score was significantly higher for b = 3000 s/mm than b = 1000 s/mm (P < 0.05). Interobserver agreement for DWI at b = 1000 s/mm and b = 3000 s/mm was very good (κ = 0.85; 95% CI, 0.63-1.00) and excellent (κ = 0.93; 95% CI, 0.78-1.00), respectively. The mean LBCR was significantly higher for DWI at b = 3000 s/mm than DWI at b = 1000 s/mm (P < 0.01).
In the detection of disseminated lesions in patients with primary malignant brain tumors, 3T DWI has an additive value relative to contrast-enhanced MR imaging. DWI at b = 3000 s/mm may be more useful than DWI at b = 1000 s/mm.
我们旨在确定3T扩散加权成像（DWI）相对于对比增强磁共振成像在检测原发性恶性脑肿瘤患者的播散性病变方面是否具有附加价值。
我们纳入了12例经手术或随访磁共振成像证实患有原发性恶性脑肿瘤结节性播散性病变的连续患者。所有患者均接受了常规磁共振成像、b值为1000和3000 s/mm²的DWI、3T下的对比剂增强T加权成像和三维梯度回波成像。对于每人最大的病变，两名放射科医生使用4分评分系统独立评估与对比剂增强磁共振图像相比DWI上额外信息的存在情况。在DWI图像上，一名放射科医生测量病变与脑的对比率（LBCR）。
与对比剂增强研究相比，放射科医生1和2分别在b = 1000 s/mm²的2例（17%）和1例（8%）DWI以及b = 3000 s/mm²的4例（33%）和5例（42%）DWI中发现病变显示更明显。其中1例患者，b = 3000 s/mm²时的平均评分显著高于b = 1000 s/mm²（P < 0.05）。b = 1000 s/mm²和b = 3000 s/mm²时DWI的观察者间一致性分别为非常好（κ = 0.85；95% CI，0.63 - 1.00）和优秀（κ = 0.93；95% CI，0.78 - 1.00）。b = 3000 s/mm²时DWI的平均LBCR显著高于b = 1000 s/mm²时的DWI（P < 0.01）。
在检测原发性恶性脑肿瘤患者的播散性病变方面，3T DWI相对于对比增强磁共振成像具有附加价值。b = 3000 s/mm²的DWI可能比b = 1000 s/mm²的DWI更有用。
