弥散加权成像中“靶征”对良恶性周围神经鞘瘤细胞密度的评估价值。
Imaging cellularity in benign and malignant peripheral nerve sheath tumors: Utility of the "target sign" by diffusion weighted imaging.
机构信息
The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins Medical Institutions, 600 North Wolfe Street, Baltimore, MD 21287, United States of America.
The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins Medical Institutions, 600 North Wolfe Street, Baltimore, MD 21287, United States of America; Department of Oncology, The Johns Hopkins Medical Institutions, 600 North Wolfe Street, Baltimore, MD 21287, United States of America; Department of Orthopaedic Surgery, The Johns Hopkins Medical Institutions, 600 North Wolfe Street, Baltimore, MD 21287, United States of America.
出版信息
Eur J Radiol. 2018 May;102:195-201. doi: 10.1016/j.ejrad.2018.03.018. Epub 2018 Mar 16.
OBJECTIVE
To determine the utility of "target sign" on diffusion weighted imaging (DWI) and apparent diffusion coefficient (ADC) mapping for peripheral nerve sheath tumor (PNST) characterization.
MATERIALS AND METHODS
This IRB-approved, HIPAA-compliant study retrospectively reviewed the MR imaging (comprised of T2- FS, DWI (b-values 50, 400, 800 s/mmand ADC mapping), and static contrast-enhanced (CE) T1-W imaging) of 42 patients (mean age: 40 years (range 8-68 years), 48% (20/42) females) with 15 malignant PNSTs (MPNSTs) and 33 benign PNSTs (BPNSTs). MPNSTs were histologically confirmed while BPNSTs were histologically-proven or with stable clinical and imaging appearance for at least 12 months. Two radiologists assessed imaging characteristics (size, signal intensity, heterogeneity, perilesional edema or enhancement) and the presence or absence of "target sign," on each sequence. A "target sign" was defined as a biphasic pattern of peripheral hyperintensity and homogeneous central hypointensity. Descriptive statistics are reported. Cohen's κ statistic or interclass correlation coefficient (ICC) were used to evaluate interobserver agreement between two observers. Univariate and multiple logistic regression analysis were performed to identify MRI features with predictive values.
RESULTS
MPNSTs were larger than BPNSTs (6.3 ± 2.5 cm vs 3.5 ± -2.1 cm, p = 0.0002), had perilesional edema (87%(13/15) vs 18%(6/33), p < 0.0001), heterogeneous enhancement (71%(10/14) vs 13%(4/31), p = 0.0001) and perilesional enhancement (79%(11/14) vs 18%(6/31), p = 0.0001), respectively. The "target sign" was present in: 24%(8/33) BPNSTs vs 0/15 MPNST on T2-FS (p = 0.26); 39%(13/33) BPNSTs vs 20%(3/15) MPNST on DWI using b-value = 50 s/mm (p = 0.5); 55%(18/33) BPNSTs vs 6%(1/15) MPNST on DWI using b-value = 400 s/mm (p = 0.002); 48%(16/33) BPNSTs vs 6%(1/15) MPNST on DWI using b-value = 800 s/mm (p = 0.005) and 64%(21/33) benign vs 0/15 MPNST on ADC mapping(p < 0.0001). By CE-T1 imaging, 32%(10/31) BPNSTs and 7%(1/14) MPNST had a target sign(p = 0.07). The odds of an MPNST in cases with minimum ADC ≤ 1.0 × 10(-3) mm(2)/s are 150 times higher than in cases with ADC > 1.0 × 10(-3).
CONCLUSION
In this explorative study, a "target sign" suggests a benign PNST and is more often visible on DWI using high b-values and ADC maps compared with anatomic sequences.
目的
确定磁共振扩散加权成像（DWI）和表观扩散系数（ADC）图上的“靶征”在周围神经鞘瘤（PNST）特征描述中的应用价值。
材料与方法
本研究经机构审查委员会批准，并符合 HIPAA 规定，回顾性分析了 42 例患者（平均年龄 40 岁[范围：8-68 岁]，女性占 48%[20/42]）的磁共振成像（包括 T2- FS、DWI（b 值为 50、400、800 s/mm 和 ADC 图）和静态对比增强 T1-W 成像）资料，这些患者均患有 15 例恶性周围神经鞘瘤（MPNST）和 33 例良性周围神经鞘瘤（BPNST）。MPNST 通过组织学证实，BPNST 通过组织学证实或具有至少 12 个月的稳定临床和影像学表现。两名放射科医生评估了每个序列的影像学特征（大小、信号强度、异质性、瘤周水肿或强化）和“靶征”的存在情况。“靶征”定义为外周高信号和中心等信号的双相模式。报告了描述性统计数据。使用 Cohen's κ 统计或组内相关系数（ICC）评估两位观察者之间的观察者间一致性。进行单变量和多变量逻辑回归分析，以确定具有预测价值的 MRI 特征。
结果
MPNST 比 BPNST 更大（6.3±2.5 cm 比 3.5±2.1 cm，p=0.0002），瘤周水肿更常见（87%[13/15]比 18%[6/33]，p<0.0001），不均匀强化更常见（71%[10/14]比 13%[4/31]，p=0.0001）和瘤周强化更常见（79%[11/14]比 18%[6/31]，p=0.0001）。“靶征”在 T2-FS 上分别在：33%（13/33）的 BPNST 中比 0%（0/15）的 MPNST 中更常见（p=0.26）；在 DWI 中使用 b 值为 50 s/mm 时分别在 39%（13/33）的 BPNST 中比 20%（3/15）的 MPNST 中更常见（p=0.5）；在 DWI 中使用 b 值为 400 s/mm 时分别在 55%（18/33）的 BPNST 中比 6%（1/15）的 MPNST 中更常见（p=0.002）；在 DWI 中使用 b 值为 800 s/mm 时分别在 48%（16/33）的 BPNST 中比 6%（1/15）的 MPNST 中更常见（p=0.005）和在 ADC 图中分别在 64%（21/33）的良性肿瘤中比 0%（0/15）的 MPNST 中更常见（p<0.0001）。在增强 T1-W 成像中，32%（10/31）的 BPNST 和 7%（1/14）的 MPNST 具有“靶征”（p=0.07）。最小 ADC 值≤1.0×10(-3)mm(2)/s 的 MPNST 病例比 ADC 值>1.0×10(-3)mm(2)/s 的病例患 MPNST 的可能性高 150 倍。
结论
在这项探索性研究中，“靶征”提示为良性 PNST，与解剖序列相比，在使用高 b 值和 ADC 图的 DWI 上更常出现。
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