Makino Keishi, Hirai Toshinori, Nakamura Hideo, Kuroda Jun-Ichiro, Shinojima Naoki, Uetani Hiroyuki, Kitajima Mika, Yano Shigetoshi
Department of Neurosurgery, Kumamoto University, Kumamoto, Japan.
Department of Radiology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
World Neurosurg. 2018 Apr;112:e1-e6. doi: 10.1016/j.wneu.2017.10.141. Epub 2018 Feb 13.
The purpose of this study was to determine whether combined diffusion-weighted imaging and dynamic susceptibility contrast-enhanced perfusion-weighted imaging magnetic resonance imaging can be used to differentiate between common malignant brain tumors, including lymphomas and high-grade gliomas.
We evaluated 87 patients with histologically confirmed brain tumors, including 33 primary central nervous system lymphomas (PCNSLs) and 54 glioblastomas (GBMs). All patients underwent conventional magnetic resonance imaging, diffusion-weighted imaging, and perfusion-weighted imaging before surgical removal of the lesion or stereotactic biopsy.
The maximum relative cerebral blood volume (rCBV) ratios of GBMs were significantly higher than those of PCNSLs (P < 0.0001). The maximum rCBVs helped to distinguish PCNSLs from GBMs with 97.0% sensitivity, 90.7% specificity, and 0.98 area under the curve. The minimum apparent diffusion coefficients (ADCs) of PCNSLs were significantly lower than those of GBMs (P < 0.0001). At an rCBV cutoff value of 4.0 and a minimum ADC of 1.0 × 10 mm/second, it was possible to differentiate between PCNSLs and GBMs.
The combination of rCBV and ADC can facilitate the differentiation between PCNSLs and GBMs.
本研究的目的是确定联合扩散加权成像和动态磁敏感对比增强灌注加权成像磁共振成像是否可用于鉴别常见的恶性脑肿瘤，包括淋巴瘤和高级别胶质瘤。
我们评估了87例经组织学证实的脑肿瘤患者，包括33例原发性中枢神经系统淋巴瘤（PCNSL）和54例胶质母细胞瘤（GBM）。所有患者在手术切除病变或立体定向活检前均接受了常规磁共振成像、扩散加权成像和灌注加权成像。
GBM的最大相对脑血容量（rCBV）比值显著高于PCNSL（P < 0.0001）。最大rCBV有助于区分PCNSL和GBM，灵敏度为97.0%，特异性为90.7%，曲线下面积为0.98。PCNSL的最小表观扩散系数（ADC）显著低于GBM（P < 0.0001）。在rCBV临界值为4.0且最小ADC为1.0×10⁻³mm²/秒时，可以区分PCNSL和GBM。
rCBV和ADC的联合应用有助于PCNSL和GBM的鉴别。
