Department of Diagnostic Imaging, Division of Neuroradiology, QE II hospital, Dalhousie University, 5743 Southwood Drive, B3H1E6, Halifax, NS, Canada.
Department of Pathology, Dalhousie University, Halifax, Canada.
Clin Neuroradiol. 2019 Jun;29(2):263-268. doi: 10.1007/s00062-018-0664-6. Epub 2018 Feb 7.
The imaging appearance of neoplastic hematoma can be complicated by the presence of a large hematoma, even on magnetic resonance imaging (MRI). We describe the role of MR perfusion (MRP) in detecting neoplastic hematomas in patients with intraparenchymal hematoma (IPH).
A retrospective review was performed for consecutive patients with IPH, where MRP was performed. Routine, post-gadolinium MRI and MRP were analyzed. All patients were either operated on for evacuation of IPH or followed up on imaging. The MRP parameters of cerebral blood volume (CBV) and cerebral blood flow (CBF) and pattern of enhancement (peripheral linear vs. nodular) were recorded. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) were calculated for these parameters for diagnosing neoplastic hematoma.
Of 116 patients with MRP, 16 patients (male 8; mean age-65.5 years) had IPH on their initial MRI. For diagnosing neoplastic hematoma, the sensitivity, specificity, PPV and NPV for increased CBF and CBV were 100%, 88.9%, 87.5%, and 100%; for peripheral linear enhancement were 100%, 28.6%, 50%, 100% and for nodular enhancement were 85.7%, 77.8%, 75% and 12.5%, respectively. The combination of peripheral linear enhancement and increased CBF and CBV showed 100% sensitivity, specificity, PPV and NPV.
In our small series, the combination of peripheral linear enhancement and increased CBF and CBV showed 100% sensitivity, specificity, PPV and NPV for diagnosing a neoplastic hematoma. These findings need to be validated in a larger study.
即使在磁共振成像（MRI）上，大血肿的存在也会使肿瘤性血肿的影像学表现变得复杂。我们描述了磁共振灌注（MRP）在检测脑实质血肿（IPH）患者中肿瘤性血肿的作用。
对连续接受 IPH 治疗且进行了 MRP 的患者进行了回顾性研究。对常规、钆后 MRI 和 MRP 进行了分析。所有患者均接受了 IPH 清除术或影像学随访。记录了脑血容量（CBV）和脑血流量（CBF）以及增强模式（周边线性与结节状）等 MRP 参数。计算了这些参数诊断肿瘤性血肿的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。
在 116 例接受 MRP 的患者中，16 例（男性 8 例；平均年龄 65.5 岁）在初始 MRI 上有 IPH。对于诊断肿瘤性血肿，高 CBF 和 CBV 的敏感性、特异性、PPV 和 NPV 分别为 100%、88.9%、87.5%和 100%；周边线性增强分别为 100%、28.6%、50%和 100%；结节状增强分别为 85.7%、77.8%、75%和 12.5%。周边线性增强和高 CBF 和 CBV 的联合使用具有 100%的敏感性、特异性、PPV 和 NPV。
在我们的小系列中，周边线性增强和高 CBF 和 CBV 的联合使用对诊断肿瘤性血肿具有 100%的敏感性、特异性、PPV 和 NPV。这些发现需要在更大的研究中得到验证。
