磁共振扩散加权成像在脑脓肿诊断与鉴别诊断中的应用.doc

磁共振扩散加权成像在脑脓肿诊断与鉴别诊断中的应用 【摘要】 目的：评价磁共振扩散加权成像（DWI）在脑脓肿诊断及与颅内囊性、坏死性肿瘤鉴别诊断中的应用价值。方法：对14例脑脓肿与17例颅内囊性、坏死性肿瘤的DWI信号特征进行分析，测量并比较病灶的表观扩散系数 (ADC) 值、病灶与对照区的ADC值比率(ADC率，rADC)。结果: 全部脑脓肿病例(14/14)在DWI上均显示为程度不等的高信号，12例(12/14)在ADC图上呈低信号，平均ADC值为（0.62±0.29）×10-3mm2/ s，平均rADC为0.77±0.36；囊性、坏死性肿瘤有15例(15/17)在DWI上显示为低信号，16例(16/17)在ADC图上呈高信号，平均ADC值为（2.37±0.70）×10-3mm2/ s，平均rADC为3.24±1.08。统计分析显示脑脓肿与囊性坏死性肿瘤的平均ADC值及rADC的差异均有显著性意义（P0.01），DWI及ADC图在脑脓肿的诊断敏感度和特异度均显著高于CT及常规MRI。结论: DWI与ADC能有效反映脓肿与囊性、坏死性肿瘤的不同液态性质，在脑脓肿的诊断与鉴别诊断中具有重要价值。 【关键词】 磁共振成像 扩散加权成像 脑脓肿 诊断 鉴别诊断价值 Application of MR Diffusion-weighted Imaging in Diagnosis and Differential diagnosis for Brain Abscess 【Abstract】 objective: To determined whether diffusion-weighted imaging (DWI) can be used to distinguish brain abscess from cystic or necrotic intracranial tumors and discuss its value. Methods: Signal intensity on DWI of 14 patients with brain abscess and 17 with cystic or necrotic intracranial tumors was analyzed . The Apparent Diffusion Coefficient (ADC) of the lesion and the ratio of the lesion ADC to control region (rADC) was calculated and compared. Results: Increased signal was seen in all of the pyogenic abscess cavities to variable degrees on DWI. ADC maps showed low signal intensity in the 12 case. The mean ADC and rADC was (0.62±0.29)?0-3mm2/ s and 0.7 7±0.36 respectively . Decreased signal was seen in 15 case of cystic or necrotic tumors on DWI and 16 had high signal intensity in their cystic or necrotic area on ADC maps. The mean ADC was (2.37±0.70)?0-3mm2/s and rADC 3.24a±1.08. Conclusions: DWI and ADC can reflect the different fluid properties of abscess and cystic or necrotic tumors very effectively, and have great value in the diagnosis and differentiation of brain abscess. 【Key words】 Magnetic resonance imaging Diffusion-weighted Imaging Brain abscess Diagnosis Differential diagnosis . 脑脓肿为颅内严重感染性疾病，近20余年来随着医疗卫生条件的改善和诊疗水平的提高，脑脓肿的流行病学发生了很大变化，隐源性脑脓肿发病率明显升高，其表现为病史长、感染症状不明显，CT和常规MRI上与颅内囊性、坏死性肿瘤难以区别，其中主要