利用动脉自旋标记和动态对比增强磁共振成像对原发性中枢神经系统淋巴瘤与高级别胶质瘤和脑转移瘤进行鉴别。
Differentiation of primary central nervous system lymphoma from high-grade glioma and brain metastasis using arterial spin labeling and dynamic contrast-enhanced magnetic resonance imaging.
机构信息
Department of Radiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, 710032, China.
Department of Neurosurgery, Xijing Institute of Clinical Neuroscience, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China.
出版信息
Eur J Radiol. 2019 Mar;112:59-64. doi: 10.1016/j.ejrad.2019.01.008. Epub 2019 Jan 8.
BACKGROUND AND PURPOSE
Conventional magnetic resonance imaging (MRI) is sometimes difficult to distinguish primary central nervous system lymphoma (PCNSL) from other malignant brain tumors effectively. The study aimed to evaluate the diagnostic performance of arterial spin labeling (ASL) and dynamic contrast-enhanced (DCE)-derived permeability parameters to differentiate PCNSL from high-grade glioma (HGG) and brain metastasis.
MATERIALS AND METHODS
Eight patients with PCNSL, twenty one patients with HGG and six brain metastasis underwent preoperative 3.0-T MR imaging including conventional, ASL and DCE. Quantitative parameters including relative cerebral blood flow (rCBF), extravascular extracellular volume fraction (V) and the volume transfer constant (K) among PCNSL, HGG and metastasis were compared with a one-way analysis of variance. In addition, the area under the receiver-operating characteristic (ROC) curve (AUC) was constructed to evaluate the differentiation diagnostic performance of each parameter and the combination.
RESULTS
The PCNSL demonstrated significantly lower rCBF, higher K and V compared with HGG and metastasis. For the ROC analyses, both K and rCBF had good diagnostic performance for discriminating PCNSL from HGG and metastasis, with the AUC of 0.880 and 0.889. With the combination of rCBF and K, the diagnostic ability for PCNSL was improved with AUC of 0.986.
CONCLUSION
rCBF and K are useful parameters for differentiating PCNSL from HGG and brain metastasis. The combination of rCBF and K further helps to improve the diagnostic performance of PCNSL.
背景与目的
常规磁共振成像（MRI）有时难以有效区分原发性中枢神经系统淋巴瘤（PCNSL）和其他恶性脑肿瘤。本研究旨在评估动脉自旋标记（ASL）和动态对比增强（DCE）衍生的渗透性参数在区分 PCNSL 与高级别胶质瘤（HGG）和脑转移瘤中的诊断性能。
材料与方法
8 例 PCNSL 患者、21 例 HGG 患者和 6 例脑转移瘤患者在术前接受了 3.0T MR 成像，包括常规 MRI、ASL 和 DCE。比较了 PCNSL、HGG 和转移瘤之间的相对脑血流量（rCBF）、血管外细胞外容积分数（V）和体积转移常数（K）等定量参数，并采用单因素方差分析进行比较。此外，构建了受试者工作特征（ROC）曲线下面积（AUC），以评估每个参数和组合的鉴别诊断性能。
结果
PCNSL 的 rCBF 明显低于 HGG 和转移瘤，K 和 V 明显高于 HGG 和转移瘤。ROC 分析显示，K 和 rCBF 均具有良好的鉴别诊断性能，用于区分 PCNSL 与 HGG 和转移瘤，AUC 分别为 0.880 和 0.889。结合 rCBF 和 K，诊断能力得到提高，AUC 为 0.986。
结论
rCBF 和 K 是区分 PCNSL 与 HGG 和脑转移瘤的有用参数。rCBF 和 K 的结合进一步有助于提高 PCNSL 的诊断性能。
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