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目的探讨MRI联合~(18)F-脱氧葡萄糖(~(18)F-FDG)PET和~(11)C-蛋氨酸(~(11)C-MET)PET显像对颅内肿胀性脱髓鞘病变与胶质瘤的鉴别诊断价值。方法纳入经病理学直接证实或内科保守治疗间接证实的14例颅内肿胀性脱髓鞘病变患者和17例胶质瘤患者,采用MRI观察病变与周围正常脑组织界限,T1WI、T2WI和扩散加权成像(DWI)信号强度,强化征象(包括环状强化和开环状强化等),占位效应,周围脑水肿,病变中心静脉扩张,胼胝体受累,病变中心坏死,灰质受累情况;~(18)F-FDG PET和~(11)C-MET PET显像对代谢程度进行视觉分析。结果 MRI显示,颅内肿胀性脱髓鞘病变患者占位效应0级8例(8/14)、Ⅰ级4例(4/14)、Ⅱ级1例(1/14)、Ⅲ级1例(1/14),周围脑水肿Ⅰ度12例(12/14)、Ⅱ度2例(2/14);胶质瘤患者占位效应0级2例(2/17)、Ⅰ级6例(6/17)、Ⅱ级7例(7/17)、Ⅲ级2例(2/17),周围脑水肿Ⅰ度7例(7/17)、Ⅱ度10例(10/17),组间差异均有统计学意义(Fisher确切概率法:P=0.032,0.024)。~(18)F-FDG PET和~(11)C-MET PET显像对颅内肿胀性脱髓鞘病变与胶质瘤的鉴别诊断差异无统计学意义(Fisher确切概率法:P=0.182,0.081)。结论 MRI显示的占位效应和周围脑水肿可以用于鉴别诊断颅内肿胀性脱髓鞘疾病与胶质瘤,PET-CT对症状类似胶质瘤的颅内肿胀性脱髓鞘病变无明确诊断价值。
Objective To investigate the effect of MRI combined with ~ (18) F-FDG PET and ~ (11) C-methionine (~ (11) C-MET) PET imaging on intracranial swelling demyelination Lesions and gliomas in the differential diagnosis. Methods Fourteen patients with intracranial swelling and demyelination and 17 patients with glioma indirectly confirmed by pathology or conservative medical treatment were enrolled in the study. The pathological changes of the lesions were compared with the surrounding normal brain tissue, T1WI, T2WI and diffusion weighted DWI signal intensities, signs of enhancement (including ring enhancement and open-loop enhancement), mass effect, peripheral cerebral edema, central venous dilatation of the lesion, corpus callosum involvement, focal necrosis and gray matter involvement; F-FDG PET and ~ (11) C-MET PET imaging were used to visualize the degree of metabolism. Results MRI showed that in patients with intracranial tumescent demyelinating lesions, the mass effect was 8 (8/14) in grade 0, 4 in grade Ⅰ (4/14), 1 in grade Ⅱ (1/14) and 1 in grade Ⅲ (1/14) in peripheral brain edema, 12 cases (12/14) in peripheral edema, 2 cases (2/14) in grade Ⅱ, 2 cases (2/17) in grade 0, 6 cases in grade Ⅰ (6/17), grade 7 (7/17), grade 2 (2/17), degree of peripheral edema in 7 cases (7/17), grade Ⅱ in 10 cases (10/17) The differences between the two groups were statistically significant (Fisher exact test: P = 0.032,0.024). There was no statistically significant difference between ~ (18) F-FDG PET and ~ (11) C-MET PET imaging on differential diagnosis of intracranial swelling demyelinating lesions and glioma (Fisher exact test: P = 0.182, 0.081). Conclusion The mass effect and peripheral cerebral edema revealed by MRI can be used to differentiate intracranial swelling demyelinating diseases from gliomas. PET-CT has no definite diagnosis on intracranial swelling demyelinating lesions with similar symptoms of gliomas value.