Medina L S, Zurakowski D, Strife K R, Robertson R L, Poussaint T Y, Barnes P D
Department of Radiology, Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
AJNR Am J Neuroradiol. 1998 Mar;19(3):529-34.
Our purpose was to determine the sensitivity, specificity, and receiver operator characteristic (ROC) curve of a fast screening MR protocol in children and adolescents with suspected intracranial tumors.
One hundred forty-one patients (mean age, 9.7 years; range, 2 months to 23.5 years) with suspected brain tumor were entered in a case-control study. Eighty-seven patients had intracranial tumors (31 suprasellar/hypothalamic, 27 supratentorial, 26 infratentorial, and three pineal) and 54 patients in the control group had other disorders. Two neuroradiologists reviewed blindly a detailed three-sequence conventional protocol (acquisition time, 8 minutes 27 seconds) and a two-sequence fast screening MR protocol (acquisition time, 4 minutes 44 seconds).
Sensitivity and specificity of the fast screening protocol for intracranial tumors was 100% and 92.6%, respectively. The areas under the ROC curves were 0.966 for the fast screening and 0.980 for the conventional MR protocol. No diagnostic performance difference was found between the ROC curves using the Az index. A kappa statistic of .93 for both examinations indicated excellent interobserver agreement. Additional MR sequences and other neuroimaging studies were not deemed necessary to exclude the presence of an intracranial tumor.
A fast dual-plane brain MR protocol may be adequate to screen children and adolescents thought to have an intracranial tumor. The less than 5 minute acquisition time allows a complete examination (including preparation) to be performed in 10 to 15 minutes. Future studies are recommended before this time-efficient neuroimaging examination is incorporated into clinical practice.
我们的目的是确定一种快速筛查磁共振成像（MR）方案在疑似颅内肿瘤的儿童和青少年中的敏感性、特异性及受试者工作特征（ROC）曲线。
141例疑似脑肿瘤患者（平均年龄9.7岁；范围2个月至23.5岁）纳入病例对照研究。87例患者患有颅内肿瘤（31例鞍上/下丘脑肿瘤、27例幕上肿瘤、26例幕下肿瘤和3例松果体肿瘤），对照组54例患者患有其他疾病。两名神经放射科医生对一份详细的三序列传统方案（采集时间8分27秒）和一份两序列快速筛查MR方案（采集时间4分44秒）进行了盲法评估。
快速筛查方案对颅内肿瘤的敏感性和特异性分别为100%和92.6%。快速筛查方案的ROC曲线下面积为0.966，传统MR方案为0.980。使用Az指数，ROC曲线之间未发现诊断性能差异。两项检查的kappa统计值均为0.93，表明观察者间一致性极佳。未认为需要额外的MR序列和其他神经影像学检查来排除颅内肿瘤的存在。
一种快速的双平面脑部MR方案可能足以筛查疑似患有颅内肿瘤的儿童和青少年。不到5分钟的采集时间允许在10至15分钟内完成完整检查（包括准备工作）。在将这种高效的神经影像学检查纳入临床实践之前，建议进行进一步研究。
