82例脑实质结核和肺癌脑转移瘤的MRI鉴别

摘要/Abstract

摘要： 目的探讨MRI，尤其是增强MRI及弥散加权成像（diffusion weighted imaging，DWI）对脑实质结核及肺癌脑转移瘤的诊断与鉴别。方法对42例脑实质结核和40例肺癌脑转移瘤患者，行MRI平扫、钆喷酸葡胺（Gd-DTPA）增强和DWI扫描。分析2者MRI表现特点，测量病灶各部分的表观扩散系数（apparent diffusion coefficient，ADC）值和病灶与对侧相应部位正常脑实质ADC值的比值（relative apparent diffusion coefficient，rADC值），采用SPSS 13.0软件进行统计学t检验和卡方检验。结果 42例脑实质结核均为多发性结节，82.56%（374/453）病灶直径<1.0 cm；T₁WI增强图像上33.77%（153/453）的病灶呈均匀结节状强化、66.23%（300/453）呈环形强化，环壁厚薄较均匀、内外壁较光滑，约36.42%（165/453）的病灶周围存在不同程度水肿，以轻、中度为主。而32.50%（13/40）的肺癌脑转移瘤呈单发结节，41.01%(57/139)病灶直径<1.0 cm，T₁WI增强图像上4.32%(6/139)病灶呈均匀结节状强化、9.35%(13/139)呈不均匀斑片状强化、86.33%(120/139)病灶呈环形强化，仅19.17%(23/120)的瘤壁厚薄较均匀，余表现为壁毛糙或伴壁结节，75.54%(105/139)的病灶周围存在水肿，且以中、重度水肿为主。脑实质结核实性部分、壁平均ADC值［分别为（0.97±0.15）×10^-3mm²/s和（1.07±0.20）×10^-3mm²/s］，均低于肺癌脑转移瘤的实性部分、壁ADC值［分别为（1.10±0.25）×10^-3mm²/s和（1.28±0.32）×10^-3mm²/s］，相应t值分别为3.648、5.051，P值均<0.001，差异有统计学意义。结论增强MRI可显示脑实质结核及肺癌脑转移瘤病灶的不同形态特点，DWI和ADC值能反应2种疾病组织微观结构变化，有助于两者的鉴别。

关键词: 结核, 脑膜/诊断, 肺肿瘤, 脑肿瘤, 磁共振成像

Abstract: Objective To explore the value of MRI，especially contrast-enhanced MRI and diffusion weighted imaging (DWI) in differentiating parenchymal tuberculosis from brain metastases of lung cancer. Methods The conventional MRI and DWI were performed in 82 cases (42 cases with parenchymal tuberculosis, and 40 cases with brain metastases from lung cancer). The mean apparent diffusion coefficient (ADC) values and relative apparent diffusion coefficient (rADC) values were calculated from the lesions. Datas are analyzed by SPSS 13.0 software packet, and using t test. Results Forty-two cases of parenchymal tuberculosis all showed multi-focus, 82.56% (374/453) of lesions were smaller than 1.0 cm,33.77% (153/453) of lesions were evenly enhanced with nodosity, the others showed ring-like contrast enhancement on Gd-DTPA enhanced T₁WI,and the rim had uniform thickness, the inner and outer walls were smooth. About 36.42% (165/453) of lesions had mild or moderate edema. 32.50% (13/40) of brain metastases from lung cancer showed solitary, 41.01% (57/139) of lesions were smaller than 1.0 cm, 4.32% (6/139) of lesions were evenly enhanced with nodosity, the others showed ring-like or patchy contrast enhancement on Gd-DTPA enhanced T₁WI, About 19.17% (23/120) of the rims showed uniform thickness, the others were coarse or accompanied by a nodule. About 75.54% (105/139) of lesions had moderate or severe edema.The ADC values of the solid center and the rim of parenchymal tuberculosis were (0.97±0.15）×10^-3mm²/s,（1.07±0.20）×10^-3mm²/s, they were lower than the ADC values from the solid and cystic lesions of brain meta-stases from lung cancer which were（1.10±0.25）×10-³mm²/s and（1.28±0.32）×10^-3mm²/s respectively, there was statistical significance. Conclusion Contrast-enhanced MRI could clearly display the morphological features, size and adjacent relationships of parenchymal tuberculosis and brain metastases from lung cancer, DWI and the ADC values could display the alterations of the microscopic structure of the tissue. Combination of contrast-enhanced MRI and DWI are helpful in diagnosis and differential diagnosis of these two diseases.

Key words: Tuberculosis,meningeal/diagnosis, Lung neoplasms, Brain neoplasms, Magnetic resonance imaging

过丽芳周新华谢汝明吕岩贺伟. 82例脑实质结核和肺癌脑转移瘤的MRI鉴别[J]. 中国防痨杂志, 2011, 33(12): 785-789.

GUO Li-fang, ZHOU Xin-hua, XIE Ru-ming, LV Yan, HE Wei. The value of contrast-enhanced MRI and diffusion weighted imaging in 82 cases differentiating parenchymal tuberculosis from brain metastases from lung cancer[J]. Chinese Journal of Antituberculosis, 2011, 33(12): 785-789.

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