Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA.
J Neuroimaging. 2022 Nov;32(6):1177-1184. doi: 10.1111/jon.13028. Epub 2022 Jul 25.
Differentiating schwannomas and metastases in the cerebellopontine angles (CPA)/internal auditory canals (IAC) can be challenging. This study aimed to assess the role of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced MRI (DCE-MRI) to differentiate schwannomas and metastases in the CPA/IAC.
We retrospectively reviewed 368 patients who were diagnosed with schwannomas or metastases in the CPA/IAC between April 2017 and February 2022 in a single academic center. Forty-three patients had pretreatment DWI and DCE-MRI along with conventional MRI. Normalized mean apparent diffusion coefficient ratio (nADCmean) and DCE-MRI parameters of fractional plasma volume (Vp), flux rate constant (Kep), and forward volume transfer constant were compared along with patients' demographics and conventional imaging features between schwannomas and metastases as appropriate. The diagnostic performances and multivariate logistic regression analysis were performed using the significantly different values.
Between 23 schwannomas (15 males; median 48 years) and 20 metastases (9 males; median 61 years), nADCmean (median: 1.69 vs. 1.43; p = .002), Vp (median: 0.05 vs. 0.20; p < .001), and Kep (median: 0.41 vs. 0.81 minute ; p < .001) were significantly different. The diagnostic performances of nADCmean, Vp, and Kep were 0.77, 0.90, and 0.83 area under the curves, with cutoff values of 1.68, 0.12, and 0.53, respectively. Vp was identified as the most significant parameter for the tumor differentiation in the multivariate logistic regression analysis (p < .001).
DWI and DCE-MRI can help differentiate CPA/IAC schwannomas and metastases, and Vp is the most significant parameter.
在桥小脑角（CPA）/内听道（IAC）中区分神经鞘瘤和转移瘤具有挑战性。本研究旨在评估弥散加权成像（DWI）和动态对比增强 MRI（DCE-MRI）在区分 CPA/IAC 中的神经鞘瘤和转移瘤中的作用。
我们回顾性分析了 2017 年 4 月至 2022 年 2 月期间在一家学术中心被诊断为 CPA/IAC 神经鞘瘤或转移瘤的 368 例患者。43 例患者在治疗前进行了 DWI 和 DCE-MRI 检查以及常规 MRI。比较了神经鞘瘤和转移瘤患者的常规影像特征和 DWI 及 DCE-MRI 各参数（标准化平均表观弥散系数比 nADCmean 和血浆容积分数 Vp、流量速率常数 Kep、正向容积转移常数），采用具有统计学差异的参数进行诊断效能分析和多因素逻辑回归分析。
23 例神经鞘瘤（15 例男性；中位年龄 48 岁）和 20 例转移瘤（9 例男性；中位年龄 61 岁）患者间，nADCmean（中位数：1.69 比 1.43；p =.002）、Vp（中位数：0.05 比 0.20；p <.001）和 Kep（中位数：0.41 比 0.81 分钟；p <.001）存在显著差异。nADCmean、Vp 和 Kep 的诊断效能曲线下面积分别为 0.77、0.90 和 0.83，其截断值分别为 1.68、0.12 和 0.53。Vp 在多因素逻辑回归分析中是肿瘤鉴别诊断的最显著参数（p <.001）。
DWI 和 DCE-MRI 有助于区分 CPA/IAC 中的神经鞘瘤和转移瘤，Vp 是最显著的参数。
