目的 探討囊性腦膜瘤的磁共振表現、表觀彌散系數（ADC）圖的影像特點、ADC值與病理分級的關系及ADC值對判斷不同病理亞型腦膜瘤的價值。 方法 回顧性分析2003年3月－2007年12月18例經病理證實的囊性腦膜瘤患者的磁共振表現，其中男8例，女10例，平均年齡45.6歲。在ADC圖上分別測量腫瘤實質、瘤周水腫、囊變區的平均ADC值（均取4～6個區域，取平均值），比較不同病理亞型、不同病理分級的腫瘤實質、瘤周水腫、囊變區的ADC值差異是否有統計學意義。 結果 良惡性腦膜瘤腫瘤實質ADC值差異無統計學意義（P＞0.05）；囊性腦膜瘤各亞型間的腫瘤實質、瘤周水腫的ADC值差異無統計學意義（P＞0.05）；腫瘤實質、囊變區與瘤周水腫平均ADC值相比差異均有統計學意義（P＜0.05）。 結論 ADC值可區分腫瘤實質、囊變區及瘤周水腫，但對腦膜瘤亞型及良惡性的甄別需結合常規MRI與增強的征象。Objective To explore the MRI imaging manifestation, features of apparent diffusion coefficient (ADC) map and the relationships among ADC value, pathologic grading and pathologic subtype of cystic meningioma. Methods The clinical data of 18 patients (8 males and 10 females, with an average age of 45.6 years) with cystic meningiomas confirmed by pathologically examination were retrospectively analyzed. The ADC values of tumor parenchyma, peritumoral edema, cystic regions and the contralateral normal brain of the tumor parenchyma were measured and analyzed.The ADC value of the tumor parenchyma, peritumoral edema, cystic region were measured and then compared with the pathological findings. P value of less than 0.05 was considered as having a statistically significant difference. Results There was no significant difference in ADC values between benign and malignant meningioma and also among the tumor parenchyma, periedema and cystic region in different pathological subtypes. The difference in ADC values amongst tumor parenchyma, peritumoral edema and cystic region were statistically significant (P＜0.05). Conclusions Although ADC quantitative measurement allows the differentiation of the tumor parenchyma, cystic region and peri-edema, it is need to combined with conventional MR examination to assess tumor malignancy as well as grading in cystic meningioma.
【摘要】 目的 探討磁共振動態增強掃描及磁共振彌散加權成像（diffusion weighted imaging，DWI）對肝癌經導管動脈內化學栓塞（transcatheter arterial chemoembolization，TACE）治療后的腫瘤殘余及復發的判斷價值。 方法 2009年1月-2010年10月，對28例經證實的肝癌患者在TACE治療前、治療后3~7 d及治療后1~2個月、3~6個月行磁共振動態增強及DWI掃描，動態測量表觀彌散系數（apparent diffusion coefficient，ADC）值，與數字減影血管造影（digital substraction angiography，DSA）檢查對照，評價動態增強掃描及DWI對腫瘤殘留或復發的檢出能力。〖HTH〗結果 對腫瘤殘余及復發的顯示，動態增強掃描靈敏度為90.0%，特異度為96.9%；DWI靈敏度為96.7%，特異度為93.8%；動態增強掃描與DWI相結合的靈感度為100.0%，特異度為99.5%；DSA靈敏度和特異度分別為96.7%、100.0%。TACE治療前所有腫瘤實質的ADC值為（1.134±0.014）×10-3 mm2/s；TACE治療后3~7 d ADC值為（1.162±0.016）×10-3 mm2/s；TACE治療后1~2個月碘油沉積較好，無明顯殘余或復發病灶的ADC值為（1.175±0.015）×10-3 mm2/s，3~6個月后隨訪病灶ADC值為（1.179±0.017）×10-3 mm2/s；TACE治療后1~2個月碘油沉積不完全或無明顯沉積病灶ADC值為（1.147±0.016）×10-3 mm2/s，3~6個月后隨訪病灶實質平均ADC值（1.142±0.012）×10-3 mm2/s。 結論 將動脈增強掃描與DWI相結合可提高對TACE治療后肝癌殘余及復發判斷的靈敏度及特異度；對腫瘤組織平均 ADC值的動態測量、觀察可及早判斷腫瘤復發的可能性。【Abstract】 Objective To evaluate the dynamic contrast-enhanced MRI and diffusion weighted imaging (DWI) in judging the remnant and recurrence on hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE). Methods Between January 2009 and October 2010, 28 patients with HCC underwent dynamic contrast-enhanced MRI and DWI before and after TACE 3-7 days, 1-2 months and 3-6 months, respectively, and the apparent diffusion coefficient (ADC) value of the tumor were also measured at above mentioned time points. The sensitivity and specificity of dynamic contrast-enhanced MRI and DWI in diagnosis of residual tumor and recurrent cancer was qualitatively evaluated by comparing with the DSA results. Results Compared with DSA, the sensitivity and specificity of dynamic contrast-enhanced MRI were 90.0% and 96.9% by revealing the remnant and recurrence of HCC, while the sensitivity and specificity of DWI were 96.7% and 93.8% respectively. Combining dynamic contrast-enhanced MRI and DWI the sensitivity and specificity were improved to 100.0% and 99.5%, respectively. The mean ADC value of tumor before and after 3-7 days of TACE were (1.134±0.014)×10-3 and (1.162±0.016)×10-3 mm2/s, respectively. The mean ADC value of tumor without and with remnant and recurrence after 1-2 months and 3-6 months follow up were (1.175±0.015)×10-3, and (1.179±0.017)×10-3 mm2/s; (1.147±0.016)×10-3 and (1.142±0.012)×10-3 mm2/s, respectively. Conclusions Combining dynamic contrast-enhanced MRI and DWI could improve the sensitivity and specificity to detect the remnant and recurrence of HCC after TACE. Measuring the ADC value during follow up of HCC patients after TACE could predict the probability of tumor recurrence.
目的 探討腦膠質瘤術后不同時期的MRI增強表現，客觀分析其術后的手術切除程度。 方法 2009年2月－2012年10月32例腦膠質瘤患者均在術后1 d～2周進行第1次MRI平掃及增強掃描（其中21例在術后3 d內進行檢查），術后1～3個月隨訪復查21例，術后6～12個月隨訪復查18例，術后1～3年MRI隨訪16例。分析不同時期的MRI平掃及增強表現，以期發現正確評價手術切除程度的指標。 結果 術后3 d內行MRI增強檢查僅有4例出現反應性強化，腫瘤殘余有7例，結合其影像學表現可較準確地區分術后反應性強化及腫瘤殘余。 結論 膠質瘤術后早期（3 d內）進行MRI增強檢查可準確評價腫瘤術后切除程度，便于制訂下一步治療計劃。