Zhong Y H, Yang Q, Liu Z, Wang Y F, Li L, Wen J, Liu L J, Luo D H
Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital&Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, China.
Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. Beijing 100021, China.
Zhonghua Zhong Liu Za Zhi. 2021 Apr 23;43(4):466-471. doi: 10.3760/cma.j.cn112152-20190313-00153.
To investigate the clinical value of magnetic resonance imaging (MRI) plain scan and diffusion weighted imaging (DWI) in the diagnosis of brain metastases. The MRI plain imaging findings of 105 cases with brain metastases and 103 cases without brain metastases confirmed by enhanced MRI examination and clinical diagnosis were retrospectively analyzed. The comparisons of plain MRI findings including T1 weighted image (T1WI), T2WI, T2/fluid attenuated inversion recovery (T2/FLAIR), DWI and apparent diffusion coefficient (ADC) values were made between brain metastases and non-brain metastases. The numbers of hypo-intensity, iso-intensity, hyper-intensity and heterogeneous signal intensity of T1WI in the brain metastatic group were 54, 23, 9 and 19, respectively, while the numbers of hypo-intensity and iso-intensity in the non-brain metastatic group were 52 and 51, respectively, with statistically significant difference (<0.001). The numbers of hypo-intensity, iso-intensity, hyper-intensity and heterogeneous signal intensity of T2WI in the brain metastatic group were 1, 9, 72 and 23, respectively, while the numbers of iso-intensity and hyper-intensity in the non-brain metastatic group were 11 and 92, respectively, with statistically significant difference (<0.001). The numbers of hypo-intensity, hyper-intensity and heterogeneous signal intensity of DWI in the brain metastatic group were 4, 31 and 65, respectively, while the number of hyper-intensity in the non-brain metastatic group was 4 and others were iso-intensity, respectively, with statistically significant difference (<0.001). The numbers of hypo-intensity, iso-intensity, hyper-intensity and heterogeneous signal intensity of T2WI/FLAIR in the brain metastatic group were 4, 5, 60 and 36, respectively, while all cases in the non-brain metastatic group were hyper-intensity, with statistically significant difference (<0.001). The number of lesion accompanied with peripheral edema in the brain metastatic group were 69 cases, significantly higher than 0 cases in the non-brain metastatic group (<0.001). The mean ADC value in the brain metastatic group were (0.919±0.019)×10(-3) mm(2)/s, significantly lower than (1.098±0.012)×10(-3) mm(2)/s of non-brain metastatic group (<0.05). For patients with a history of primary malignancy, the MRI plain scan signals of T1WI, T2WI, T2WI/FLAIR and DWI are significantly different between brain metastatic tumor and non-metastatic tumor. The mixed signal, peripheral edema and the restriction of DWI diffusion indicate brain metastases. The combined application of the above parameters can improve the diagnostic efficacy of predicting brain metastases, and contrast enhancement MRI examination should be performed for the confirmation of diagnosis.
探讨磁共振成像(MRI)平扫及弥散加权成像(DWI)在脑转移瘤诊断中的临床价值。回顾性分析105例经增强MRI检查及临床诊断确诊为脑转移瘤患者和103例无脑转移瘤患者的MRI平扫影像表现。比较脑转移瘤组与非脑转移瘤组在T1加权像(T1WI)、T2加权像(T2WI)、T2加权液体衰减反转恢复序列(T2/FLAIR)、DWI及表观扩散系数(ADC)值等MRI平扫表现的差异。脑转移瘤组T1WI低信号、等信号、高信号及混杂信号的例数分别为54、23、9和19例,而非脑转移瘤组低信号和等信号的例数分别为52和51例,差异有统计学意义(<0.001)。脑转移瘤组T2WI低信号、等信号、高信号及混杂信号的例数分别为1、9、72和23例,而非脑转移瘤组等信号和高信号的例数分别为11和92例,差异有统计学意义(<0.001)。脑转移瘤组DWI低信号、高信号及混杂信号的例数分别为4、31和65例,而非脑转移瘤组高信号的例数为4例,其余为等信号,差异有统计学意义(<0.001)。脑转移瘤组T2WI/FLAIR低信号、等信号、高信号及混杂信号的例数分别为4、5、60和36例,而非脑转移瘤组所有病例均为高信号,差异有统计学意义(<0.001)。脑转移瘤组伴有瘤周水肿的病例有69例,显著高于非脑转移瘤组的0例(<0.001)。脑转移瘤组的平均ADC值为(0.919±0.019)×10⁻³mm²/s,显著低于非脑转移瘤组的(1.098±0.012)×10⁻³mm²/s(<0.05)。对于有原发恶性肿瘤病史的患者,脑转移瘤与非转移瘤在T1WI、T2WI、T2WI/FLAIR及DWI的MRI平扫信号有显著差异。混合信号、瘤周水肿及DWI扩散受限提示脑转移瘤。上述参数联合应用可提高预测脑转移瘤的诊断效能,确诊需行增强MRI检查。