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Comparative Analysis of MRI Manifestation of Different Cerebral Meatastasis and the Clinical Application of Swi in the Diagnosis of Cerebral Metastasis

Author: WangWei
Tutor: MiaoYanWei
School: Dalian Medical University
Course: Medical Imaging and Nuclear Medicine
Keywords: brain metastases magnetic resonance imaging susceptibility-weightedimaging
CLC: R445.2
Type: Master's thesis
Year: 2012
Downloads: 8
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Objective: To retrospectively analysis the conentional MRI and SWI finding ofcerebral metastasies,to expore the MRI manifestation of different cerebral metastaseand the application value of SWI in.Meterials and Methods:200cases of pathologically or clinically confirmed patients with brain metastaseswere recruited in the study.The MR study were performed with by SIEMENS1.5Tavanto high field magnetic resonance scanner,Eight-channel head coil excitation andsignal acquisition, T1WI, T2WI scan and contrast-enhanced T1WI data wererequaired.Of which87cases of patients were aslo performed with SWI.All the datawere analysed by two radiologists independantly,Including location, amount, shape,morphology, substance of the tumor signal characteristics (Including hemorrhage,necrosis, vascular, etc.) and measurement (relative value of T2=T2tumorparenchyma/contralateral normal-appearing white matterT2values) tumor edema andenhancement patterns, agreements were reached by jiont consultation.Chi-square test wasuesed to analyze the differences of the different histological types of brain metastasesbetween the MRI findings in the tumor; And lung cancer and breast cancer tumors inreal terms in T2relative value for the ROC curve analysis. At the same time, analysisand compare87routine the SWI check of brain metastases, tumor hemorrhage, thedetection rate of the blood vessels.Results:1、The200cases of brain metastases both by clinical or pathology and there are144brain metastases from lung cancer,24brain metastases from breast cancer,12brain metastases from liver cancer,11brain metastases from rectal cancer,4brainmetastases from esophageal cancer,3brain metastases from ovarian cancer,2brain metastases from thyroid carcinoma,1brain metastases from bladder cancer.2、Location: according to the anatomic site,Brain metastases is in common inparietal lobe(172,29.86%), in occipital lobe(133,23.09%),in temporal lobe(98,17.01%),in frontal lobe(87,15.10%),in the cerebellum and the brain stem(70,12.15%),in basal ganglia(16,2.77%) secondly. According to cerebral arteryblood supply in anterior cerebral artery(64,11%), middle cerebral artery(265,46%),vertebrobasilar artery(248,43%). Occurred in the blood supply to the internal carotidartery tumor kitchen more than vertebrobasilar arteries supply of blood area (329,248).Brain metastases from lung adenocarcinoma is in parietal lobe(93/172),occipital lobe(68/133), from small cell lung cancer is in temporal lobe(32/98); fromsquamous cell carcinoma is in frontal lobe(35/87); from breast cancer is in thecerebellum and the brain stem(34/70).3、Number, shape, size and tumor weeks edema:In this experiment there are200cases and576lesions and174cases are multiple lesions, for example lungadenocarcinoma68cases,87.18%; lung squamous cell carcinoma cases,77.78%; smallcell lung carcinoma28cases,96.88%; pulmonary large carcinoma cell6cases,85.74%;breast cancer22cases,91.67%; liver cancer10cases,83.33%; rectal cancer9cases,81.81%,same to esophagus cancer4cases, melanoma2cases, bladder cancer1cases.26cases(13%) are Single lesions,576lesions, respectively of a round or circular (136cases,68%) and irregularshape (64cases,32%). The diameter of tumor is from3mm to54mm,averages about25mm.576lesions and56with no surrounding edema, the others all have differentdegrees of edema belt around. Different tissue types of brain metastases have edemaand degree the same week with significant difference (P <0.001)4、Signal changes and measurement in tumor parenchyma4.1Parenchyma signal changes in tumor: Intracranial metastases plain scan T1multi-display or slightly low and T2high signal intensity, where T1signal (35,6.48%),T2low signal (47,8.70%). With bleeding manifestations of mixed T1, T2signal;enhanced scan three cases no enhancement factors because the condition ofblood and blood circulation, the remaining573lesions showed homogeneousenhancement, heterogeneous enhancement, ring enhancement of the respectivenumbers for the333(58.12%),126(21.99%),114(19.90%). Not find metastasislesions17cases of plain scan, Contrast injection in order to show metastases,38cases by the after injection of contrast medium enhanced scan, found were more plain scanincreased. The signal intensity of melanoma brain metastases to metastases short T1signal; rectal cancer the main display to single necrotic tumor center or eccentric longT1, T2signal.4.2Parenchyma signal measure in tumor: Relative T2value (rT2) measured inthis group of researchers found that lung adenocarcinoma metastatic brain tumor andbreast cancer brain metastases were significantly different, cause march ROC curveanalysis, area under curve0.722(95%CT,0.523~0.831), relative T2value can be usedto identify lung adenocarcinoma and breast cancer brain metastases, diagnosticcapabilities in general, boundary value of1.715(sensitivity+specificity of thehighest), a sensitivity of70.3%(17/24), the specificity was66.7%(16/24).4.3Heterogeneity analyses of tumor parenchyma signal: The X2value of necrosisand cystic degeneration in tumor, hemorrhage in tumor, drainage vascular, tumoredema, boundary are26.548,40.533,23.555,25.915, There were significant or highlysignificant difference and there is statistical significance (P<0.05). Of brainmetastases of lung cancer tumor necrosis rate was significantly higher than breastcancer, liver cancer and colorectal cancer, adenocarcinoma lesions in gradeⅠ<10mmnecrosis within the tumor incidence is high, squamous cell carcinoma the highestnecrosis rate (66.65%), to achieve tumor hemorrhage in lung adenocarcinoma(55.32%), drainage of blood vessels is more common in squamous cell carcinomas,(3%in6cases) no edema of metastases due to metastatic sites, Gd-DTPAenhancementno enhancement scan in three cases due to vascular conditions and thefactors of the blood circulation.5、Based on the T1WI plain sequence scanning images, Some patients (87cases)there were39cases of hemorrhage in tumor were detected by SWI sequenceand20cases were detected by T1WI sequence. SWI sequence more than T1WIsequence detected19cases of tumor bleeding lesions, detection of intratumoralhemorrhage and clarity are more than two, T1WI sequence detection of intratumoralhemorrhage may be detected by the SWI sequence, Different pathological types ofbleeding detected in two sequences correspond to P <0.05, statistically significantdifference between the two groups. In addition, SWI can clearly show the tumorblood vessels and the number, especially for the detection of low flow rate and smallblood vessels better. This group of87cases, T1WI eight drainage of blood vessels,SWI showed a total of17drainage of blood vessels, there is patency statistical significance (P <0.01).Conclusion:1、Can be found through the analysis of larger sample of brain metastases of MRimaging, the MRI features of the different sources of metastases to get the reversespeculated that their sources may be metastases from the analysis of signs.2、Lung cancer brain metastases, squamous cell carcinoma metastasis more likelyto occur within the tumor necrosis, adenocarcinoma metastasis is more prone tointratumoral hemorrhage and peritumoral edema.3、The tumor parenchyma relative T2signal intensity values measured in order tofurther quantify the diagnosis derived from different tissues transfer provides a newway of thinking.4、SWI is a useful complement to the conventional sequence, especially fordetection of tumor bleeding and tumor blood vessels should be widely used clinically.

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CLC: > Medicine, health > Clinical > Diagnostics > Diagnostic Imaging > Magnetic resonance imaging
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