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目的分析颅内血管外皮细胞瘤(HPC)与不典型脑膜瘤(AM)MRI征象的差异,并探究DWI和ADC值对两者的鉴别诊断价值。材料与方法收集经手术病理证实的20例HPC与31例AM患者术前的MR平扫、增强扫描以及DWI检查的影像学资料,对其MRI征象进行对比分析,计数资料组间比较采用χ~2检验;测量两组肿瘤实质的平均ADC值,计量资料组间比较采用两样本t检验,运用ROC曲线评价ADC值的鉴别诊断价值。结果 20例HPC与31例AM相比,肿瘤形状(χ~2=4.763,P<0.05)、出血(χ~2=8.400,P<0.01)、血管流空信号(χ~2=26.793,P<0.001)、瘤脑界面(χ~2=4.432,P<0.05)、与附着硬膜的关系(χ~2=15.093,P<0.001)、脑膜尾征(χ~2=9.670,P<0.01)、强化方式(χ~2=8.025,P<0.01)、强化均匀性(χ~2=5.097,P<0.05)8项影像学征象差异有统计学意义;T2WI信号(χ~2=3.227,P>0.05)、坏死囊变(χ~2=0.658,P>0.05)、瘤周水肿程度(χ~2=0.056,P>0.05)、邻近骨质改变(χ~2=2.588,P>0.05)4项影像学征象差异无统计学意义。前者肿瘤多呈分叶状、不规则形,囊变坏死,出血及肿瘤内血管流空信号多见,瘤脑界面较清晰,增强后明显不均匀强化,多窄基底与硬膜相连,脑膜尾征少见;后者肿瘤多呈类圆形或椭圆形,囊变坏死及出血少见,瘤脑界面多较模糊,增强后多明显均匀强化,多宽基底与硬膜相连,脑膜尾征多见。20例HPC在DWI上均呈等或稍高信号,ADC均值为(1.21±0.14)×10~(-3) mm~2/s,31例AM在DWI上28例呈高或稍高信号,3例呈低信号,ADC均值为(0.82±0.12)×10~(-3) mm~2/s,低于HPC,差异有统计学意义(t=10.39,P<0.001)。以ADC值1.07×10~(-3) mm~2/s作为HPC与AM的诊断阈值时,ROC曲线下面积等于0.98±0.01,95%可信区间为0.95~1.00,灵敏度为90%,特异度为100%,准确率为90%。结论颅内HPC与AM的MRI征象存在一定差异,ADC值在两者的鉴别诊断中具有重要参考价值,可提高其诊断准确率。
Objective To analyze the difference of MRI features between intracranial hemangiopericytoma (HPC) and atypical meningiomas (AM), and to explore the differential diagnosis between DWI and ADC. Materials and Methods Imaging data of 20 cases of HPC and 31 cases of AM with pathologically proven pathology were collected before and after MR scan, contrast enhanced scan and DWI examinations. MRI signs were compared and analyzed. 2 test. The average ADC value of the two groups of tumor parenchyma was measured. Two sample t-test was used to compare the measurement data. The ROC curve was used to evaluate the differential diagnosis value of ADC value. Results Compared with 31 cases of AM, 20 cases of HPC showed significant differences in tumor shape (χ ~ 2 = 4.763, P <0.05), hemorrhage (χ ~ 2 = 8.400, (Χ ~ 2 = 9.693, P <0.05), and the relationship between the dura mater (χ ~ 2 = 15.093, P <0.001) (Χ ~ 2 = 5.025, P <0.05). There were significant differences in the 8 radiographic signs between the two groups (χ ~ 2 = 8.025, P <0.01) (Χ ~ 2 = 0.658, P> 0.05), degree of peritumoral edema (χ ~ 2 = 0.056, P> 0.05) and adjacent bone changes There was no significant difference in the four imaging signs. The former mostly lobulation lobular, irregular shape, cystic degeneration, bleeding and tumor vascular flow signal more common, tumor brain interface clearer, significantly enhanced after the uneven enhancement of the more narrow base and dura connected to the end of the meninges Levy rare; the latter mostly round or oval tumors, cystic degeneration and bleeding rare, tumor-brain interface more fuzzy, enhanced significantly enhanced after more than the width of the base associated with the dura mater, common meningeal sign. All 20 cases of HPC showed equal or slightly higher signal intensity on DWI, the average ADC value was (1.21 ± 0.14) × 10 -3 mm 2 / s, and the high or slightly higher signal intensity was found in 31 cases of AMI on DWI. 3 cases showed low signal intensity, and the mean ADC value was (0.82 ± 0.12) × 10 -3 mm 2 / s, lower than that of HPC. The difference was statistically significant (t = 10.39, P <0.001). When the ADC value was 1.07 × 10 -3 mm 2 / s, the area under the ROC curve was 0.98 ± 0.01, the 95% confidence interval was 0.95-1.00, the sensitivity was 90%, and the specificity Degree of 100%, the accuracy rate of 90%. Conclusion There are some differences in the MRI features of intracranial HPC and AM. ADC value has important reference value in the differential diagnosis of both, which can improve the accuracy of diagnosis.