Nghiên cứu giá trị hệ số khuếch tán biểu kiến của cộng hưởng từ trong chẩn đoán phân biệt u thần kinh đệm độ cao với u di căn não đơn độc

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Tác giả: Dương Mỹ Vân Âu, Nguyên Phương Thảo Nguyễn

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y Dược học Phạm Ngọc Thạch, 2024

Mô tả vật lý: tr.125

Bộ sưu tập: Metadata

ID: 286414

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Mục tiêu: Xác định độ nhạy, độ đặc hiệu hệ số khuếch tán biểu kiến trong chẩn đoán phân biệt u thần kinh đệm độ cao và u di căn não đơn độc. Phương pháp: Nghiên cứu được thực hiện tại bệnh viện Nhân dân 115 từ 01/01/2020 đến 30/06/2024 thu thập được 119 trường hợp (gồm 51 trường hợp u di căn não đơn độc và 68 trường hợp u thần kinh đệm độ cao) đã được chụp cộng hưởng từ (CHT) thường quy có tiêm thuốc tương phản từ và CHT khuếch tán. Thiết kế hồi cứu, mô tả hàng loạt ca. Đo đạc các giá trị hệ số khuếch tán biểu kiến (ADC) vùng u, vùng phù quanh u và chất trắng bình thường đối bên, từ đó tính toán các tỉ số ADC. Phân tích đường cong ROC xác định điểm cắt giúp phân biệt hai loại u. Kết quả: Giá trị ADC nhỏ nhất và trung bình vùng phù quanh u (ADCpmin, ADCptb) và tỉ số của chúng với chất trắng bình thường đối bên (rADCpmin, rADCptb) của nhóm u thần kinh đệm độ cao (UTKĐĐC) thấp hơn có ý nghĩa thống kê so với u di căn não đơn độc (UDCNĐĐ) với p <
0,001. Với điểm cắt ADCpmin và ADCptb lần lượt là 1,362 x 10 - 3mm2/s và 1,370 x 10 - 3mm2/s cho độ nhạy 82,35%, độ đặc hiệu 77,94% trong chẩn đoán phân biệt UTKĐĐC với UDCNĐĐ. Đồng thời với điểm cắt là 1,76 của tỉ số rADCpmin (có độ nhạy 86,27%, độ đặc hiệu 76,47%) và 1,79 của rADCptb (có độ nhạy độ đặc hiệu lần lượt là 86,27% và 77,94%) cũng giúp phân biệt hai loại u trên. Không có sự khác biệt có ý nghĩa thống kê về các giá trị và tỉ số ADC vùng u giữa UTKĐĐC với UDCNĐĐ. Kết luận: Các giá trị ADC vùng phù quanh u và tỉ số của chúng với chất trắng bình thường đối bên giúp chẩn đoán phân biệt UTKĐĐC với UDCNĐĐ với độ nhạy và độ đặc hiệu tương đối cao. Abstract Objectives: To determine the sensitivity and specificity of apparent diffusion coefficient (ADC) in distinguishing between high-grade gliomas (HGG) and solitary brain metastases (SBM). Methods: The study was performed at People’s Hospital 115 from 01/01/2020 to 30/6/2024, with 119 cases including 51 cases of SBM and 68 cases of HGG. All patients underwent conventional MRI with contrast injection and diffusion-weighted MRI. This study was a descriptive, retrospective cross-sectional series of cases. ADC values were measured in the tumor area, the peritumoral edema, and the contralateral normal white matter, and calculated the ADC ratios. ROC curve analysis was performed to determine the cutoff points that would help differentiate between the two types of tumors. Results: The minimum and average ADC values of the peritumoral edema (ADCpmin, ADCptb) and their ratios to the contralateral normal white matter (rADCpmin, rADCptb) were significantly lower in HGGs than those in SBMs with p <
0.001. According to ROC curve analysis, a cutoff value of 1,362 x 10 - 3mm2/s for the ADCpmin and 1,370 x 10 - 3mm2/s, for the ADCptb generated the best combination of sensitivity (82,4%) and specifiity (77,9%) for distinguishing between HGGs and SBMs. Additionally, the cutoff points of 1.76 for rADCpmin (with a sensitivity of 86.3% and a specificity of 76.5%) and 1.79 for rADCptb (with a sensitivity of 86.27% and a specificity of 77.9%) also helped to differentiate between the two tumor above. There was no significant difference in the ADC values of the tumor area or their ratios between HGGs and SBMs. Conclusions: ADC values of the peritumoral edema and their ratios to the contralateral normal white matter can differentiate HGG from SBM with relatively high sensitivity and specificity. The ADC values of the tumor area do not play a role in differentiating between the two tumor types. DOI: 10.59715/pntjmp.3.4.15

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