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目的探讨MRI图像纹理分析对鉴别原发性脑淋巴瘤与高级别胶质瘤(HGG)的临床应用价值。方法回顾性分析经病理证实的15例原发性脑淋巴瘤与18例HGG患者的MRI表现,并对T1WI增强图像进行纹理分析,分别得到熵值、偏度、峰度及异质性等相关参数。结果原发性脑淋巴瘤好发于深部脑组织,如胼胝体区、额叶及基底节区,在MRI表现为T1WI呈等、低信号,T2WI呈等、稍高信号,边界较清,增强后多呈均匀明显强化;HGG在MRI表现为T1WI呈低信号,T2WI呈高信号,增强扫描后呈明显不均匀强化,病灶内部多伴有囊变、坏死及出血成分。原发性脑淋巴瘤与HGG比较,多发病灶、强化方式和累及中线特征在统计学上存在显著差异(P<0.05);纹理分析脑淋巴瘤组和HGG组中T1WI增强图像,脑淋巴瘤组的熵值与异质性参数低于HGG组的熵值与异质性参数,两者在统计学上存在显著差异(P<0.05)。同时,纹理分析异质性参数明显优于熵值;当异质性参数Cut-off点取0.175时,鉴别诊断脑淋巴瘤与HGG的敏感性、特异性和准确性分为86.7%、94.4%和90.9%。结论纹理分析的熵值、异质性参数结合常规MRI平扫和增强表现,对鉴别原发性脑淋巴瘤与HGG具有一定的临床应用价值。
Objective To investigate the clinical value of MRI image texture analysis in distinguishing primary brain lymphoma from high grade gliomas (HGG). Methods The MRI findings of 15 cases of primary brain lymphoma and 18 cases of HGG confirmed by pathology were retrospectively analyzed. The texture of T1WI enhanced images was analyzed, and the correlations of entropy, skewness, kurtosis and heterogeneity were obtained parameter. Results Primary brain lymphoma predominantly developed in deep brain tissue, such as the corpus callosum area, frontal lobe and basal ganglia. The MRI showed T1WI was equal, low signal, T2WI was slightly higher signal, the border was clear, enhanced HGG showed low signal on T1WI, high signal on T2WI and obvious uneven enhancement on enhanced scan. Most lesions were accompanied by cystic degeneration, necrosis and hemorrhage. Compared with HGG, there were statistically significant differences in the features of multiple lesion, enhancement mode and midline involvement between the primary brain lymphoma and the HGG group (P <0.05); Texture analysis of T1WI enhanced images in brain lymphoma group and HGG group, The entropy and heterogeneity parameters of HGG group were lower than those of HGG group (P <0.05). At the same time, the heterogeneity parameters of texture analysis were significantly better than those of entropy. When the cut-off point of heterogeneity was 0.175, the sensitivity, specificity and accuracy of differential diagnosis of brain lymphoma and HGG were 86.7% and 94.4% And 90.9%. Conclusion Texture analysis of the entropy, heterogeneity parameters combined with conventional MRI scan and enhanced performance, for the identification of primary brain lymphoma and HGG has some clinical value.