摘要：

目的 探讨MRI 联合¹⁸F-脱氧葡萄糖（¹⁸F-FDG）PET 和¹¹C-蛋氨酸（¹¹C-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；¹⁸F-FDG PET 和¹¹C-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）。¹⁸F-FDGPET 和¹¹C-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。

关键词: 脱髓鞘疾病, 中枢神经系统, 神经胶质瘤, 磁共振成像, 体层摄影术, 发射型计算机

Abstract:

Objective  To explore the value of MRI combined with ¹⁸F-fluoro-2-deoxy-D-glucose (¹⁸F-FDG) PET and ¹¹C-methionine (¹¹C-MET) PET on differentiating tumefactive demyelinating lesion (TDL) and glioma.  Methods  Fourteen cases of TDL and 17 cases of glioma were confirmed by pathology directly or internal medicine treatment. MRI was used to observe the lesion boundary, T₁WI, T₂WI and diffusion - weighted imaging (DWI) signal intensity, enhancement (including ring enhancement and open - ring enhancement, etc.), mass effect, peripheral edema, and the presence of central venectasia, corpus callosum engagement, central necrosis and gray matter engagement. ¹⁸F-FDG PET and ¹¹C-MET PET were used to calculate relative uptake values.  Results  Among all TDL cases, MRI showed that mass effect of 8 cases (8/14) were grade 0, 4 cases (4/14) gradeⅠ, one case (1/14) was gradeⅡ and one case (1/14) gradeⅢ; the peripheral edema of 12 cases (12/14) were gradeⅠand 2 cases (2/14) gradeⅡ. Among all glioma cases, the mass effect of 2 cases (2/17) were grade 0, 6 cases (6/17) gradeⅠ, 7 cases (7/17) gradeⅡand 2 cases (2/17) grade Ⅲ; the peripheral edema of 7 cases (7/17) were grade Ⅰ and 10 cases (10/17) grade Ⅱ. The differences between TDL and glioma were statistically significant (Fisher's exact probability: P = 0.032, 0.024). ¹⁸F-FDG PET and ¹¹C-MET PET were not statistically significant in differentiating TDL and glioma (Fisher's exact probability: P = 0.182, 0.081).  Conclusions  Mass effect and peripheral edema showed in MRI can be used for the differential diagnosis of TDL and glioma. The value of PET-CT in differentiating TDL and glioma is unsure.

Key words: Demyelinating diseases, Central nervous system, Glioma, Megnetic resonance imaging, Tomography, emission-computed