ESWAN序列在星形细胞肿瘤分级及鉴别诊断中的应用

摘要

目的:探讨ESWAN序列在星形细胞肿瘤分级及鉴别诊断中的作用；方法:回顾性分析复旦大学附属华山医院东院手术的脑星形细胞肿瘤患者35例及其他类型病变39例.行常规MRI、增强T1 FLAIR及GEESWAN序列扫描,根据各种肿瘤内ITSS数目将其分级.结果:低级别星形细胞肿瘤、间变型星形细胞瘤、胶质母细胞瘤的ITSS分级具有显著差异；并且随着肿瘤级别增高,ITSS分级增高,提示星形细胞肿瘤随着级别的增高,其血管增殖及微出血相应增多.高ITSS分级(3级)可用于鉴别诊断GBM/HAT与淋巴瘤,但是不能鉴别GBM/HAT与颅内孤立性转移瘤.结论:通过ESWAN序列扫描,经ITSS分级检测,对星形细胞肿瘤的分级具有重要意义,并且有助于鉴别GBM/HAT和颅内孤立性淋巴瘤.%Purpose:To assess the clinical value of ESWAN sequence in pathological grading and differential diagnosis of brain astrocytomas.Methods:MR Images of 74 patients with confirmed astrocytoma,lymphoma,solitary metastatic tumor,leyomyosarcoma,melanoma,menigioma,schwanoma,hemangioblastoma,and medulloblastoma were analyzed.MR imaging was performed on a 1.5T system (SIGNA EXCITE,GE,US),and conventional MR imaging protocol included:axial T1WI,T2WI,FLAIR,DWI,enhanced T1WI and ESWAN.Magnitude images from ESWAN were post-processed with MinIP to clearly display the intracranial veins and microbleeds.Intratumoral susceptibility signal intensity (ITSS)of different tumors was classified.The ITSSs grades and phase values in different grade astrocytomas were compared.SPSS 16.0 was used for the statistical analysis.Results:There was a significant difference among the groups of low-grade astrocytomas,anaplastic astrocytomas and GBM; the grade of ITSS increased with the malignancy of astrocytoma.It was demonstrated that the higher grade the astrocytoma,the more vascular proliferation and microbleeds would exist.High degree of ITSS (Grade 3) could be used to distinguish GBM/HAT from lymphoma,rather than GBM/HAT and solitary metastatic tumors.Conclusion:The application of ITSSs and phase values from ESWAN plays a significant role in grading of astrocytoma,and differentiating GBM/HAT from intracranial solitary lymophoma.