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目的探讨磁共振扩散加权成像(DWI)和动态增强在颅底脊索瘤和侵袭性垂体瘤(IPA)鉴别诊断中的应用价值。方法搜集经手术病理证实且影像学有鞍区破坏的颅底脊索瘤患者15例、向鼻咽部侵犯的IPA患者20例。测量二者的表观扩散系数(ADC)值,绘制受试者工作特征曲线(ROC),分析动态增强曲线的类型,统计达峰时间(TTP)、增强峰值(EP)和最大对比增强率(MCER),分析各个参数在鉴别诊断中的价值。结果颅底脊索瘤的ADC值为(1.274±0.07)×10~(-3)mm~2/s,高于IPA ADC值(0.672±0.03)×10~(-3)mm~2/s(P<0.001),ADC阈值为0.964×10~(-3)mm~2/s时,ROC曲线下面积为0.997,敏感度为93.3%,特异度为100%。颅底脊索瘤时间-信号强度曲线(TIC)Ⅰ型14例,TICⅢ型1例,此例TICⅢ型者TTP约40 s;IPA TICⅠ型7例,TICⅢ型13例。颅底脊索瘤和IPA的EP、MCER差异均有统计学意义(P<0.001)。结论 ADC值和TIC的类型及其相关参数(EP,MCER)有助于颅底脊索瘤和IPA之间的鉴别。
Objective To investigate the value of diffusion weighted imaging (DWI) and dynamic contrast enhancement in differential diagnosis of skull base chordoma and invasive pituitary adenoma (IPA). Methods Fifteen patients with skull base chordoma who had been proved by operation and pathology and whose saddle zone was damaged by imaging were collected and 20 patients with IPA were recruited to nasopharynx. The apparent diffusion coefficient (ADC) values of the two groups were measured, and the receiver operating characteristic curve (ROC) was plotted. The types of dynamic enhancement curves, statistical peak time (TTP), peak enhancement (EP) and maximum contrast enhancement MCER) to analyze the value of each parameter in differential diagnosis. Results The ADC value of skull base chordoma was (1.274 ± 0.07) × 10 ~ (-3) mm ~ 2 / s, which was higher than that of IPA (0.672 ± 0.03) × 10 ~ (-3) mm ~ 2 / s P <0.001). The area under the ROC curve was 0.997 when ADC threshold value was 0.964 × 10 -3 mm 2 / s, with a sensitivity of 93.3% and a specificity of 100%. There were 14 cases of type Ⅰ skull base chordoma time-signal intensity curve (TIC), 1 case of TICⅢ type, TTP of TICⅢ type was about 40 seconds in this case, 7 cases of IPA TICⅠtype and 13 cases of TICⅢ type. There were significant differences in EP and MCER between skull base chordoma and IPA (P <0.001). Conclusion The types of ADC value, TIC and its related parameters (EP, MCER) are helpful for the identification of skull base chordoma and IPA.