摘要目的：探究表观扩散系数（ADC）及动态增强（DCE）MRI对鉴别诊断原发性中枢神经系统淋巴瘤（Primary central nervous system lymphoma，PCNSL）与脱髓鞘假瘤（Demyelinating pseudotumor，DPT）的价值。方法：回顾性分析经病理证实的35例PCNSL及11例DPT患者的MRI资料，通过分析其年龄、性别、ADC、时间-信号强度曲线（TIC）类型、峰值（SImax）、达峰时间（Tmax）和最大对比增强率（MCER），比较两种肿瘤的差异。评价ADC及DCE-MRI鉴别诊断PCNSL与DPT的效能。采用两独立样本t检验、校正t检验、卡方检验及秩和检验的统计学方法。结果：PCNSL与DPT的ADC、MCER（（0.75±0.22）×10-3 mm2/s vs （1.25±0.05）×10×10-3 mm2/s，（115.74±7.71）% vs （32.57±3.81）%）比较有统计学意义（P<0．05）。绘制ROC曲线后，鉴别PCNSL与DPT的ADC、MCER阈值分别是0.915×10-3 mm2/s、53.35%。PCNSL 3例Ⅰ型、10例Ⅱ型、22例Ⅲ型，DPT 2例Ⅰ型、2例Ⅱ型、7例Ⅲ型。而两种肿瘤的年龄、性别、SImax、Tmax无统计学意义（P>0．05）。结论：PCNSL的ADC值小于DPT的ADC值，PCNSL的MCER值大于DPT的MCER值，MCER较ADC更具价值，这些参数有助于鉴别诊断。
Abstract：Objective: To assess the value of ADC and DCE-MRI in differentially diagnosing of primary central nervous system lymphoma and demyelinating pseudotumor. Methods: A total of 35 cases of PCNSL and 11 cases of the DPT confirmed by pathology were analyzed retrospectively. All of patients underwent MR scans which were obtained ADC and DCE-MRI data. Age, gender, ADC, TIC, SImax, Tmax, and MCER were measured and compared between PCNSL and DPT. The diagnostic efficacy of ADC and DCE-MRI were calculated. Two independent samples t tests, t’ test, chi-square test and Wilcoxon rank sum test were used to do statistically. Results: The ADC value((0.75±0.22)×10-3 mm2/s), MCER((115.74±7.71)%) of 35 cases of PCNSL were statistically different from 11 cases of the DPT((1.25±0.05)×10-3 mm2/s, (32.57±3.81)%). The cut-off value of ADC and MCER were respectively 1.03×10×10-3 mm2/s and 226.7% in differential diagnosis of PCNSL and DPT. There were 3 type Ⅰ TICs, 10 type Ⅱ TICs, 22 type Ⅲ TICs in 35 cases of PCNSL. There were 2 type Ⅰ TICs, 2 type Ⅱ TICs, 7 type Ⅲ TICs in 11 cases of the DPT. The age, gender, SImax, Tmax and EER were not statistically different between the two tumors(P>0.05). Conclusion: The ADC value of PCNSL is less than DPT’s; MCER of PCNSL is greater than DPT’s, and MCER is more valuable than ADC, and these parameters can help diagnosis.
陈 晨，任翠萍，赵瑞琛，程敬亮，文宝红. ADC及DCE-MRI对鉴别诊断原发性中枢神经系统淋巴瘤与脱髓鞘假瘤的价值[J]. 中国临床医学影像杂志, 2018, 29(8): 548-551.
CHEN Chen, REN Cui-ping, ZHAO Rui-chen, CHENG Jing-liang, WEN Bao-hong. The value of ADC and DCE-MRI in differentially diagnosing of primary central nervous system lymphoma and demyelinating pseudotumor. JOURNAL OF CHINA MEDICAL IMAGING, 2018, 29(8): 548-551.
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