表观扩散系数在鉴别皮层受累为主的胶质瘤与亚急性期脑梗死中的应用

目的探讨表观扩散系数在皮层受累为主的胶质瘤与亚急性期脑梗死中的鉴别诊断价值。材料与方法回顾性分析经手术和病理证实的24例皮层受累为主的胶质瘤及经临床证实的24例皮层受累为主的亚急性期脑梗死的常规磁共振平扫及增强表现和扩散加权成像(diffusion weighted imaging,DWI)表现,比较皮层受累胶质瘤实性部分、皮层亚急性期脑梗死实质部位及正常脑组织的表观扩散系数(apparent diffusion coefficient,ADC)值。结果 24例皮层受累为主的胶质瘤包含低级别胶质瘤10例,高级别胶质瘤14例,共发现27个病灶,肿瘤实质部分DWI呈稍高或等信号,肿瘤实质部分平均ADC值为(1.21±0.16)×10-3 mm2/s,其中低级别胶质瘤肿瘤实性部分ADC值为(1.28±0.17)×10-3 mm2/s,高级别胶质瘤实性成分平均ADC值为(1.01±0.22)×10-3 mm2/s,对侧正常大脑半球平均ADC值为(0.84±0.07)×10-3 mm2/s,肿瘤与正常脑实质的ADC值差异有统计学意义(P0.05);皮层受累为主的亚急性期脑梗死在DWI上表现为高或稍高信号,其ADC值明显低于对侧正常脑实质,病变平均ADC值为(0.49±0.07)×10-3 mm2/s,皮层受累为主的胶质瘤实性部分与皮层受累为主的亚急性期脑梗死实质部分平均ADC值差异有统计学意义(P0.05)。结论皮层受累为主的胶质瘤与皮层亚急性脑梗死的ADC值及DWI表现结合常规MRI检查具有较高的鉴别诊断价值。

The apply value of apparent diffusion coefficient in the differential diagnosis between cortex-involved gliomas and subacute cerebral infarction

Objective: To investigate the value of apparent diffusion coefficient (ADC) in the differential diagnosis between cortex-involved gliomas and subacute cerebral infarction. Materials and Methods: The MRI data including convention MRI and diffusion weighted imaging (DWI) from 24 cases with cortex-involved gliomas confirmed by pathology and 24 cases with subacute cerebral infarction treated by formal medical therapy were retrospectively analyzed. Compare the ADC value of the solid part of cortex-involved gliomas, the central part of subacute cerebral infarction and normal brain tissue. Results: Twenty-seven lesions were detected in 24 cases with cortex-involved gliomas. There were 10 cases with low-grade gliomas and 14 cases with high-grade gliomas. On DWI, tumor substantial part showed slightly higher or medium signal intensity and necrotic area was significantly lower signal intensity. The mean ADC value of tumor substantial part was (1.21±0.16)×10-3 mm2/s. The mean ADC value of low-grade gliomas was (1.28±0.17)×10-3 mm2/s, and that of high-grade gliomas was (1.01±0.22)×10-3 mm2/s, and mean ADC value of corresponding contralateral normal area was (0.84±0.07)×10-3 mm2/s, there was significant difference in ADC values between cortex-involved gliomas and nomal tissue (P<0.05). Subacute cerebral infarction appeared as hyper-intensity on DWI, the mean ADC value was (0.49±0.07)×10-3 mm2/s. There was significant differences in ADC value between cortex-involved glioma and subacute cerebral infarction (P<0.05). Conclusions: It is of significant value to combine ADC value, DWI, conventional MRI appearance and contrast-enhanced appearance in differentiating diagnosis of cortex-involved glioma from subacute cerebral infarction.