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目的探讨扩散加权成像(DWI)、表观扩散系数(ADC)值在脊索样脑膜瘤(CM)和其他亚型脑膜瘤鉴别诊断中的价值。方法搜集本院经手术病理证实的45例脑膜瘤患者(其中CM 10例,WHOⅠ级脑膜瘤患者22例,WHOⅡ级非典型脑膜瘤9例,WHOⅢ级横纹肌样脑膜瘤3例和乳头样脑膜瘤1例)的常规MRI平扫、增强及DWI资料,然后测量肿瘤实质区的ADC、r ADC值,比较CM与其他亚型脑膜瘤的ADC、r ADC值差异,并运用受试者工作特征曲线(ROC)评价ADC、r ADC值的诊断价值。分别对CM和其他3个级别脑膜瘤的平均ADC值和r ADC值进行独立样本t检验。结果 10例CM、22例WHOⅠ级脑膜瘤、9例WHOⅡ级非典型脑膜瘤、4例WHOⅢ级脑膜瘤(横纹肌样脑膜瘤3例,乳头状脑膜瘤1例)的平均ADC值分别为(1.20±0.35)×10~(-3)mm~2/s、(0.83±0.11)×10~(-3)mm~2/s、(0.73±0.16)×10~(-3)mm~2/s、(0.69±0.13)×10~(-3)mm~2/s,平均r ADC值分别为1.57±0.48、1.12±0.18、1.03±0.10、0.98±0.23,其差异均有统计学意义(P<0.01)。ADC值和r ADC值诊断CM的ROC曲线下面积(AUC)分别为0.914±0.055和0.889±0.600,以0.903×10~(-3)mm~2/s和1.32为阈值时,诊断CM的灵敏度和特异度分别为90%与88.6%、80%与94.3%。结论 CM的ADC值和r ADC值高于其他亚型的脑膜瘤,有助于CM和其他亚型脑膜瘤的鉴别诊断,提高CM术前诊断的准确率。
Objective To investigate the value of diffusion weighted imaging (DWI) and apparent diffusion coefficient (ADC) in the differential diagnosis of chordoid meningioma (CM) and other subtypes of meningioma. Methods Forty-five patients with meningioma confirmed by surgery and pathology (including 10 cases of CM, 22 cases of WHO grade Ⅰ meningioma, 9 cases of WHO grade Ⅱ atypical meningioma, 3 cases of WHO grade Rhabdoid meningioma and 3 cases of papillary meningioma 1 cases). The ADC and r ADC values of the tumor parenchyma were measured. The difference of ADC value between ADC and other subtype meningiomas was compared. (ROC) evaluation ADC, r ADC value of the diagnostic value. Independent samples t-test was performed on mean ADC values and r ADC values of CM and other three levels of meningiomas, respectively. Results The average ADC values of 10 cases of CM, 22 cases of WHO grade Ⅰ meningioma, 9 cases of WHO grade Ⅱ atypical meningioma and 4 cases of WHO Ⅲ grade meningioma (rhabdoid meningioma, 1 case of papillary meningioma) were (1.20 ± 0.35 mm × 10 -3 mm 2 / s, 0.83 ± 0.11 × 10 -3 mm 2 / s, 0.73 ± 0.16 × 10 -3 mm 2 / s, s, (0.69 ± 0.13) × 10 ~ (-3) mm ~ 2 / s respectively. The average r ADC values were 1.57 ± 0.48, 1.12 ± 0.18, 1.03 ± 0.10 and 0.98 ± 0.23, respectively P <0.01). The area under the ROC curve (AUC) of ADC value and r ADC value in diagnosing CM were 0.914 ± 0.055 and 0.889 ± 0.600 respectively, and the sensitivity of CM was diagnosed with the threshold of 0.903 × 10 -3 mm 2 / s and 1.32 And specificity were 90% and 88.6%, 80% and 94.3%, respectively. Conclusion The ADC value and r ADC value of CM are higher than those of other subtypes. It is helpful for the differential diagnosis between CM and other subtype of meningioma and to improve the accuracy of CM preoperative diagnosis.