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目的:探讨磁共振灌注成像对脑内占位性病变鉴别诊断的价值。方法:选取55例经临床病理检查证实的脑内肿瘤病人,回顾性分析其磁共振灌注图像、随访结果,并绘制时间-信号强度曲线,比较不同类型肿瘤相对脑血容量图、相对脑血流量,和相对平均通过时间参考图及灌注曲线的特点。结果:所有入组病例经灌注成像扫描后,19例病人诊断为胶质瘤,8例诊断为脑转移瘤,5例诊断为脑原发性淋巴瘤,并经病理证实。23例胶质瘤术后放疗后病人中,15例诊断为胶质瘤术后复发,最终经二次手术和随访证实;8例诊断为胶质瘤术后放疗后放射性脑坏死,随访3~6mo病变无明显变化。结论:磁共振灌注成像可以揭示相应感兴趣区是否存在肿瘤新生血管,提供组织中微观血流动力学信息,为临床提供病理生理学信息。肿瘤内和肿瘤周围相对局部脑血容量变化及时间-信号强度曲线可对胶质瘤与转移瘤、淋巴瘤和放疗后脑坏死的鉴别诊断提供帮助,具有较高的临床应用价值。
Objective: To investigate the value of MR perfusion imaging in the differential diagnosis of space-occupying lesions in the brain. Methods: Fifty-five patients with intracranial tumors confirmed by clinicopathological examination were retrospectively analyzed. The results of follow-up and the time-signal intensity curve were drawn. The relative cerebral blood volume of different types of tumors were compared, and the relative cerebral blood flow , And the relative average through time reference plot and perfusion curve characteristics. Results: All patients were diagnosed as glioma by perfusion imaging scan, 8 cases were diagnosed as brain metastases, 5 cases were diagnosed as primary brain lymphoma and confirmed by pathology. Twenty-three cases of glioma postoperative radiotherapy patients, 15 cases diagnosed as glioma recurrence, and finally confirmed by the second surgery and follow-up; 8 cases were diagnosed as glioma postoperative radiotherapy of radioactive brain necrosis, followed up for 3 ~ 6mo lesion no significant change. Conclusion: MR perfusion imaging can reveal the existence of tumor neovascularization in the corresponding region of interest, provide microscopic hemodynamic information in tissue, and provide pathophysiology information for clinic. The changes of relative local cerebral blood volume and the time-signal intensity curve in tumor and surrounding tumor may help to differentiate glioma from metastases, lymphoma and post-radiotherapy brain necrosis, and have high clinical value.