原發(fā)性中樞神經(jīng)系統(tǒng)淋巴瘤的MR征象分析及ADC值在鑒別診斷中的價值
發(fā)布時間：2018-09-11 20:57
【摘要】：第一部分原發(fā)性中樞神經(jīng)系統(tǒng)淋巴瘤的MR征象分析及3D增強(qiáng)多平面重建的價值研究目的：探討免疫功能正常的原發(fā)性中樞神經(jīng)系統(tǒng)淋巴瘤(primary central nervous system lymphoma, PCNSL)常規(guī)MRI征象及3D多平面重建增強(qiáng)在診斷中的價值。方法：回顧性分析93例經(jīng)病理或穿刺證實為PCNSL的MRI特征,其中41例常規(guī)增強(qiáng)掃描,40例行3D多平面重建增強(qiáng)掃描,12例兩種均有檢查,并比較常規(guī)MR增強(qiáng)與3D多平面重建增強(qiáng)后對于PCNSL典型征象的檢出率。結(jié)果： 93例患者均為B細(xì)胞性非霍奇金淋巴瘤。單發(fā)49例(52.6%),多發(fā)44例(47.3%)；共檢出167個病灶。病灶好發(fā)于幕上(85%)142個病灶位于幕上,25個位于幕下,主要分布于深部腦白質(zhì)等近中線部位及靠近腦膜表面。MRI平掃病灶T1WI多呈等或稍低信號,T2WI多呈等或稍高信號。159個病灶在DWI上均呈高或稍高信號。增強(qiáng)后163個病灶實質(zhì)成分均呈團(tuán)塊狀、結(jié)節(jié)狀明顯強(qiáng)化,4個病灶無強(qiáng)化。8個出現(xiàn)“蝴蝶征”。43個病灶呈現(xiàn)典型的“馬蹄征”；81個病灶可見鄰近軟腦膜強(qiáng)化；40個病灶周圍室管膜呈現(xiàn)強(qiáng)化；23個病灶內(nèi)或周圍出現(xiàn)包繞血管征,常規(guī)MRI增強(qiáng)和3D對以上征象的顯示率分別為(17.1%、34.7%；34.3%、32.0%; 14.3%、32%； 、 10.0%； 18.7%)。結(jié)論：PCNSL的MR表現(xiàn)具有特征性,3D增強(qiáng)多平面重建技術(shù)可以提供更多的診斷信息,有助于提高該病診斷準(zhǔn)確性。第二部分rADC值在原發(fā)性中樞神經(jīng)系統(tǒng)淋巴瘤鑒別診斷中的價值研究目的：探討病灶實質(zhì)部分相對最小表觀擴(kuò)散系數(shù)(rADC)值在顱內(nèi)PCNSL、GBM及炎性脫髓鞘鑒別診斷中的價值。方法：搜集術(shù)后病理確診的PCNSL39例共47個病灶,GBM35例共42個病灶,炎性脫髓鞘8例共12個病灶的影像學(xué)資料,包括常規(guī)MRI平掃、增強(qiáng)掃描和彌散加權(quán)成像(DWI),測量病灶實質(zhì)區(qū)最小ADC值及病灶對側(cè)正常腦白質(zhì)區(qū)的平均ADC值,并計算兩者的比值相對最小ADC(rADC)。對三組病變的相對表觀擴(kuò)散系數(shù)(rADC)值進(jìn)行方差分析,并進(jìn)行兩兩比較；另應(yīng)用受試者工作特征(R0C)曲線,對rADC值在PCNSL與非PCNSL的診斷效能進(jìn)行評價。結(jié)果：顱內(nèi)淋巴瘤的病灶實質(zhì)rADC值低于GBM, GBM病灶實質(zhì)rADC值低于顱內(nèi)炎性脫髓鞘,差異有統(tǒng)計學(xué)意義(F=20.249,P=0.000)；通過Dunnett T3檢驗進(jìn)行兩兩比較,各組間差異均有統(tǒng)計學(xué)意義(P0.05); ROC曲線下面積為0.803,面積的標(biāo)準(zhǔn)誤為0.048,用rADC值判定淋巴瘤與非淋巴瘤有顯著意義(P=-0.000)。取Youden指數(shù)最大值時為判斷預(yù)后的最佳臨界點,即rADC值為0.722時,診斷敏感性0.745,特異性為0.741。結(jié)論：病灶實質(zhì)部分相對最小ADC值(rADC)有助于顱內(nèi)淋巴瘤、膠質(zhì)母細(xì)胞瘤及炎性脫髓鞘的鑒別診斷,結(jié)合DWI圖像及常規(guī)MRI平掃+增強(qiáng)可以提高淋巴瘤的診斷。
[Abstract]:Part I: MR features of primary central nervous system lymphoma and the value of 3D enhanced multiplanar reconstruction objective: to investigate the (primary central nervous system lymphoma, PCNSL) conventional MRI signs of primary central nervous system lymphoma with normal immune function The value of image and 3D multiplanar reconstruction in diagnosis. Methods: the MRI features of 93 cases of PCNSL proved by pathology or puncture were analyzed retrospectively. Among them, 41 cases were examined by conventional enhanced scan and 40 cases by 3D multiplanar reconstruction. The detection rates of typical PCNSL signs after conventional MR enhancement and 3D multiplanar reconstruction were compared. Results: all the 93 patients were B-cell non-Hodgkin's lymphoma. 49 cases (52.6%) were single, 44 cases (47.3%) were multiple, 167 lesions were detected. Most of the lesions were located on the supratentorial stage (85%). 142 lesions were located on the supratentorial stage and 25 at the subtentorial level. It was mainly distributed in the proximal middle line of the deep white matter and near the meningeal surface. The T1WI of plain scan lesions showed iso-or slightly low signal intensity on T2WI, and all 159 lesions showed high or slightly high signal intensity on DWI. After enhancement, 163 lesions showed mass, nodular enhancement, 4 lesions without enhancement, 8 lesions with "butterfly sign", 43 lesions with typical "horseshoe sign", 81 lesions with adjacent pial meningeal enhancement. The enhancement of ependymal membrane around 40 lesions and the appearance of surrounding vascular signs in or around the lesions were observed in 23 lesions. The display rates of the above signs by conventional MRI enhancement and 3D were (17.1and 34.734.73cm 32.0; 14.33232; 10.0; 18.7% respectively). ConclusionThe MR features of the MR are characterized by 3D enhanced multiplanar reconstruction, which can provide more diagnostic information and help to improve the diagnostic accuracy of the disease. The value of rADC value in differential diagnosis of Primary Central nervous system Lymphoma objective: to investigate the value of the relative minimum apparent diffusion coefficient (rADC) in the differential diagnosis of intracranial PCNSL,GBM and inflammatory demyelination. Methods: the imaging data of 47 PCNSL39 patients with 42 lesions confirmed by pathology and 12 lesions with inflammatory demyelination were collected, including routine MRI plain scan. Contrast-enhanced scanning and diffusion-weighted (DWI), were used to measure the minimum ADC value of the focus parenchyma and the average ADC value of the contralateral normal white matter area, and to calculate the ratio of the two to the minimum ADC (rADC). The relative apparent diffusion coefficient (rADC) of the three groups was analyzed and compared, and the diagnostic efficacy of rADC in PCNSL and non-PCNSL was evaluated by using R0C curve. Results: the rADC value of the lesion parenchyma of intracranial lymphoma was lower than that of GBM, GBM, and the value of rADC was lower than that of intracranial inflammatory demyelination (F _ (20.249) P ~ (0.000), and the difference was statistically significant (F _ (20.249) P ~ (0.000), and compared by Dunnett T _ 3 test. There were significant differences among the groups (P0.05 area under the); ROC curve was 0.803, the standard error of area was 0.048, the rADC value to determine lymphoma and non-lymphoma has significant significance (P0. 000). When the maximum Youden index is taken as the best critical point for prognosis, the diagnostic sensitivity is 0.745 and the specificity is 0.741when the rADC value is 0.722. Conclusion: the relative minimum ADC value of the lesion is helpful to the differential diagnosis of intracranial lymphoma glioblastoma and inflammatory demyelinating. Combined with DWI images and conventional MRI enhancement can improve the diagnosis of lymphoma.
【學(xué)位授予單位】：復(fù)旦大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R739.4;R445.2
本文編號：2237821
[Abstract]:Part I: MR features of primary central nervous system lymphoma and the value of 3D enhanced multiplanar reconstruction objective: to investigate the (primary central nervous system lymphoma, PCNSL) conventional MRI signs of primary central nervous system lymphoma with normal immune function The value of image and 3D multiplanar reconstruction in diagnosis. Methods: the MRI features of 93 cases of PCNSL proved by pathology or puncture were analyzed retrospectively. Among them, 41 cases were examined by conventional enhanced scan and 40 cases by 3D multiplanar reconstruction. The detection rates of typical PCNSL signs after conventional MR enhancement and 3D multiplanar reconstruction were compared. Results: all the 93 patients were B-cell non-Hodgkin's lymphoma. 49 cases (52.6%) were single, 44 cases (47.3%) were multiple, 167 lesions were detected. Most of the lesions were located on the supratentorial stage (85%). 142 lesions were located on the supratentorial stage and 25 at the subtentorial level. It was mainly distributed in the proximal middle line of the deep white matter and near the meningeal surface. The T1WI of plain scan lesions showed iso-or slightly low signal intensity on T2WI, and all 159 lesions showed high or slightly high signal intensity on DWI. After enhancement, 163 lesions showed mass, nodular enhancement, 4 lesions without enhancement, 8 lesions with "butterfly sign", 43 lesions with typical "horseshoe sign", 81 lesions with adjacent pial meningeal enhancement. The enhancement of ependymal membrane around 40 lesions and the appearance of surrounding vascular signs in or around the lesions were observed in 23 lesions. The display rates of the above signs by conventional MRI enhancement and 3D were (17.1and 34.734.73cm 32.0; 14.33232; 10.0; 18.7% respectively). ConclusionThe MR features of the MR are characterized by 3D enhanced multiplanar reconstruction, which can provide more diagnostic information and help to improve the diagnostic accuracy of the disease. The value of rADC value in differential diagnosis of Primary Central nervous system Lymphoma objective: to investigate the value of the relative minimum apparent diffusion coefficient (rADC) in the differential diagnosis of intracranial PCNSL,GBM and inflammatory demyelination. Methods: the imaging data of 47 PCNSL39 patients with 42 lesions confirmed by pathology and 12 lesions with inflammatory demyelination were collected, including routine MRI plain scan. Contrast-enhanced scanning and diffusion-weighted (DWI), were used to measure the minimum ADC value of the focus parenchyma and the average ADC value of the contralateral normal white matter area, and to calculate the ratio of the two to the minimum ADC (rADC). The relative apparent diffusion coefficient (rADC) of the three groups was analyzed and compared, and the diagnostic efficacy of rADC in PCNSL and non-PCNSL was evaluated by using R0C curve. Results: the rADC value of the lesion parenchyma of intracranial lymphoma was lower than that of GBM, GBM, and the value of rADC was lower than that of intracranial inflammatory demyelination (F _ (20.249) P ~ (0.000), and the difference was statistically significant (F _ (20.249) P ~ (0.000), and compared by Dunnett T _ 3 test. There were significant differences among the groups (P0.05 area under the); ROC curve was 0.803, the standard error of area was 0.048, the rADC value to determine lymphoma and non-lymphoma has significant significance (P0. 000). When the maximum Youden index is taken as the best critical point for prognosis, the diagnostic sensitivity is 0.745 and the specificity is 0.741when the rADC value is 0.722. Conclusion: the relative minimum ADC value of the lesion is helpful to the differential diagnosis of intracranial lymphoma glioblastoma and inflammatory demyelinating. Combined with DWI images and conventional MRI enhancement can improve the diagnosis of lymphoma.
【學(xué)位授予單位】：復(fù)旦大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R739.4;R445.2
【共引文獻(xiàn)】
相關(guān)碩士學(xué)位論文 前1條
1 唐潔;DWI在肺癌腦轉(zhuǎn)移和腦膠質(zhì)瘤診斷和鑒別診斷中的應(yīng)用[D];昆明醫(yī)科大學(xué);2014年
，本文編號：2237821
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