表观弥散系数在高级别胶质瘤与急性期脑梗死鉴别诊断中的应用

目的探讨表观弥散系数(ADC值)在高级别胶质瘤与急性期脑梗死鉴别诊断中的应用。方法回顾性分析经手术和病理证实的18例高级别胶质瘤及正规及时溶栓治疗的28例急性期脑梗死的常规磁共振表现和弥散加权成像(DWI)表现,对照分析高级别胶质瘤实性部分、急性期脑梗死灶中心部分及对侧正常脑组织ADC值。结果 18例高级别胶质瘤患者共发现20个病灶,其中11例病灶内合并有出血、坏死和囊变,肿瘤实质部分呈稍高信号,囊变坏死区呈明显低信号,肿瘤实质部分平均ADC值为(0.92±0.12)×10-3mm2/s,对侧相应正常部位平均ADC值为(0.79±0.09)×10-3mm2/s,差异有统计学意义(P<0.05),急性期脑梗死在DWI上表现为高或稍高信号,其ADC值明显低于对侧相应区域,平均ADC值为(0.69±0.10)×10-3mm2/s,高级别胶质瘤实性部分与急性期脑梗死平均ADC值差异有统计学意义(P<0.05)。结论 DWI表现及ADC值对高级别胶质瘤与急性期脑梗死磁共振鉴别诊断具有重要价值。

The value of apparent diffusion coefficient in the differential diagnosis between high-grade glioma and acut cerebral infarctinon

Objective To investigate the value of apparent diffusion coefficient（ADC）in the differential diagnosis between high-grade gliomas and acute cerebral infarction.Methods The MRI date including convention MRI and diffusion weighted imaging（DWI） from eighteen case with high-grade gliomas confirmed pathology and 28 cases with acute cerebral infarction treated by formal thrombolytic therapy were retrospectively analyzed.Comparative analysis the ADC value of the sold part of high-grade gliomas,the central part of acute cerebral infarction and contralateral normal brain tissue.Results Twenty lesions were detected in 18 cases with high-grade gliomas including single lesion in 16 cases and multiple lesion in 2 cases,11 cases with hemorrhage,necrosis and cystic changes.On DWI,tumor substantial part showed slightly higher signal intensity and necrotic area was significantly lower signal intensity.The mean ADC value of tumor substantial part was（0.92±0.12）×10-3 mm2/s,and that of corresponding contralateral normal area was（0.79±0.09）×10-3 mm2/s,there was significant difference in ADC values between them（P〈0.05）.Acute cerebral infarction appeared as hyper-intensity on DWI,the mean ADC value was（0.69±0.10）×10-3 mm2/s.There was significant differences in ADC value between high-grade glioma and acute cerebral infarction（P〈0.05）.Conclusion It is of significant value to combine DWI,ADC value,conventional MRI appearance and contrast-enhanced appearance in differentiating diagnosis of high-grade glioma from acute cerebral infarction.