| | | DWI及ADC值鉴别脑脓肿与坏死囊变脑转移瘤的价值
| | 药学类毕业论文 作者：黄敏华，郭勇，林伟，钱明珠，张永文
【关键词】 磁共振成像；弥散加权成像；ADC值；脑脓肿；脑肿瘤/继发性
Values of DWI and ADC in differential diagnosis between brain abscesses and necrotic or cystic metastatic brain tumors
【Abstract】 AIM: To study the values of diffusionweighted imaging (DWI) and apparent diffusion coefficient (ADC) in the differential diagnosis between brain abscesses and necrotic or cystic metastatic brain tumors. METHODS: Fourteen patients proved pathologically as brain abscess and 17 cystic/necrotic metastatic tumor underwent conventional MRI and DWI examinations. DWI signal and ADC value were evaluated in cerebritis stage, capsule formation stage, and evolution stage of brain abscess and compared with those of cystic/necrotic metastatic tumor. Chisquared test and t test were performed for statistic analysis. RESULTS: The DWI signal was high and ADC value was low in the capsule stage of abscess, which was contrary to that of cystic/necrotic tumor. The DWI signal was low or equal and ADC value was high or equal in the evolution stage or cerebritis stage, which was similar to that of cystic/necrotic tumor. The mean ADC value of all brain abscesses was (0.88×10-3) mm2/s, and that of cystic/necrotic tumor was (1.8×10-3) mm2/s; the difference was statistically significant (P<0.05). The diagnostic sensitivity, specificity and accuracy of DWI signals were 64.5% (20/31), 100% (17/17), 77% (37/48) respectively. CONCLUSION: DWI and ADC value are helpful to differentiate capsule formation stage of abscess from cystic/necrotic tumor, but not helpful to distinguish evolution stage/cerebritis stage of abscess from cystic/necrotic tumor.
【Keywords】 MRI；DWI；ADC value；brain abscess; brain neoplasms/secondary
【摘要】 目的药学类毕业论文: 研究DWI及ADC值在鉴别脑脓肿与坏死囊变脑转移瘤中的药学类毕业论文应用价值. 方法： 病理及临床证实脑脓肿14例,坏死囊变脑转移瘤17例,经常规磁共振检查及弥散加权检查，在脑脓肿脑炎期、包膜期及吸收期进行弥散信号及ADC值的测量，并与坏死囊变脑转移瘤相比较，统计学分析采用χ2检验和t检验. 结果：脑脓肿包膜期DWI为高信号，ADC值低，与坏死囊变脑转移瘤DWI及ADC值正好相反. 吸收期及脑炎期脑脓肿DWI为低信号或等信号,而ADC值高信号或等信号，与坏死囊变脑转移瘤正好相类似. 所有脑脓肿的平均ADC值为0.88×10-3 mm2/s,坏死囊变脑转移瘤平均ADC值1.8×10-3 mm2/s，两者比较有统计学差异(P<0.05). DWI信号诊断的敏感性为64.5%(20/31)，特异性为100%(17/17),准确性为77%(37/48). 结论：DWI及ADC值有助于鉴别包膜期脑脓肿与坏死囊变脑转移瘤，对吸收期脑脓肿与坏死囊变脑转移瘤的鉴别诊断无明显意义.
【关键词】 磁共振成像；弥散加权成像；ADC值；脑脓肿；脑肿瘤/继发性
0引言
磁共振弥散加权成像有助于鉴别脑脓肿与坏死囊变脑转移瘤［1-9］，但目前国内外报道的病例数很有限. 我们进一步探讨了DWI及ADC值在脑脓肿及坏死囊变脑转移瘤鉴别诊断中的应用价值.
1对象和方法
1.1对象200101/200506，行磁共振(MR)检查并证实的脑脓肿患者14例，共24个病灶，男10例，女4例，年龄7~73(平均43)岁. MR引导立体定向穿刺活检证实10例，均为细菌性脓肿. 抗炎治疗随访证实4例. 14例24个病灶中病变处于不同时期者6例. 所有病例均行MR常规检查和弥散加权成像检查并行MR随访. 坏死囊变脑转移瘤17(男12，女5)例,年龄41~80(平均61)岁，其中肺癌脑转移8例，乳腺癌脑转移2例，肾癌脑转移1例，不明原因脑转移癌6例，17例脑转移瘤均行常规MR检查，16例经临床证实. 1例经脑外科穿刺病理证实.
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