| Objective:To explore the clinical value of diffusion kurtosis imaging(DKI) technology in differentiating high-grade glioma from solitary brain metastasis.Methods:24 patients of high-grade glioma(HGG) and 14 patients of solitary brain metastasis(SBM) confirmed by pathology have been collected from September 2012 to September 2014. All patients underwent conventional MRI scanning, enhanced scanning and DKI scanning before operation. Analysis was performed by two experienced MRI physicians combined with conventional MRI scanning images. The mean kurtosis(MK)values, fractional anisotropy(FA) values and mean diffusivity(MD) values of tumor solid part, peritumoral edema and the contralateral normal-appearing white matter were measured quantitatively on the MK figure, FA figure and MD figure. The parameter values were normalized for r MK, r FA, r MD to the corresponding values in contralateral normal-appearing white matter. Compare the values between the two groups by Wilcoxon rank test, by using receiver operating characteristic(ROC) curve to assess the size of area under the curve(AUC) of each parameter value. Compare the correct rate of differential diagnosis of two diseases for conventional MRI scanning and conventional MRI combining with DKI scanning.Resluts:(1)22 cases of high-grade glioma showed different degrees of cystic degeneration,IV necrosis, among them 9 cases with hemorrhage, 7 cases of tumor through the corpus callosum to the contralateral violation; DWI image 21 showed mixed hyperintensity except one case, it showed hypointensity; Peritumoral edema in 18 cases are larger than 1cm, 6cases are less than 1cm; Enhanced scanning 10 cases showed rosette-like significantly enhancement, 9 cases showed irregular circinate significantly enhancement, 5 cases showed patchy enhancement.(2)All cases of solitary brain metastasis showed different degrees of cystic degeneration, necrosis, among them 9 cases with hemorrhage; DWI image 8 cases showed mixed hyperintensity, 4 cases showed circinate hyperintensity and one case showed hypointensity; Peritumoral edema in 12 cases are larger than 1cm, 2 cases are less than1cm; Enhanced scanning 5 cases showed irregular circinate significantly enhancement, 3cases showed rosette-like significantly enhancement, 6 cases showed inhomogeneous patchy significantly enhancement.(3)The r MK values of peritumoral edema in high-grade gliomas were significantly higher than that of brain metastases(P=0.000, P<0.05), and the r MD values of peritumoral edema in high-grade gliomas were significantly lower than that of brain metastases(P=0.014, P<0.05). The r FA values of peritumoral edema were no significant differences(P>0.05). The r MK, r FA and r MD values of tumor solid part were no significant differences between groups(P>0.05). ROC curve analysis showed that when the r MK values of peritumoral edema was 0.488, the sensitivity and specificity for the differentiation of the two diseases was 75% and 85.7% respectively, the AUC was 0.869;while when the r MD values of peritumoral edema was 1.849, the sensitivity for the differentiation of the two diseases was 85.7%, and the specificity was only 58.3%, the AUC was 0.741.(4)The differential diagnostic accuracy of conventional MRI combining with DKI scanning of the two diseases is better than the conventional MRI scanning alone(P=0.024,P<0.05).Conclusions:(1)The MK and MD values of peritumoral edema were helpful in differentiating high-grade glioma from solitary brain metastasis, the sensitivity and specificity of MK value were higher than MD value.(2)The combination of conventional MRI scanning and DKI scanning can improve the accuracy of the differential diagnosis of two diseases, DKI will become an important supplement to conventional MRI scanning in differential diagnosis of brain tumors. |
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