颅内、头颈部表皮瘤和颞骨胆脂瘤的扩散分析。

Fabrício Guimarães Gonçalves, Amirreza Manteghinejad, Zekordavar Rimba, Dmitry Khrichenko, Angela N Viaene, Arastoo Vossough
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引用次数: 0

摘要

背景和目的:颅内表皮样肿瘤(IET)、颞骨胆脂瘤(TBC)和头颈部表皮样囊肿(EC)通常是由外胚层组织引起的生长缓慢的良性疾病。它们在弥散加权成像(DWI)中显示出增高的信号。虽然许多成像文献都将这些病变描述为弥散受限,但我们的目的是研究这些定性信号强度以及与正常脑结构相比弥散受限的解释。本研究旨在定量评估这些病变的表观弥散系数(ADC)值和直方图特征:这项回顾性研究纳入了经组织学确诊为 IET、TBC 或 EC 的儿童。研究人员对病变进行了分割,并在进行直方图分析的同时计算了ADC值。ADC 计算由第二个分析软件进行验证,以确保准确性。小脑、白质和丘脑等正常脑区作为正常对照区。相关分析和Bland-Altman图评估了ADC计算软件之间的一致性。使用 Wilcoxon 秩和检验和 Kruskal-Wallis 检验评估了病变和正常脑组织之间数值分布的差异:本研究共纳入 48 例病理证实的病例。其中,13 例(27.1%)为 IET,14 例(29.2%)为 EC,21 例(43.7%)为 TBC。平均年龄为(8.67±5.30)岁,女性 27 人(52.9%)。两种软件对病变 ADC 绝对值的类内相关性为 0.997(95%CI=0.995-0.998)。IET、EC和TBC的中位ADC值没有显著差异(973.7vs.875.7vs.933.2 x10-6 mm2/s,P=0.265)。然而,三种病变类型的 ADC 值均高于三种正常脑组织类型(933vs.766, x10-6 mm2/s,p=0.265):IET、TBC 和 EC 的 ADC 值均高于正常脑区。如果不考虑用于比较的组织,简单地将这些病变归类为弥散受限或弥散率降低是不准确的。与大脑相比,DWI 上观察到的高密度可能归因于相对较高的 T2 透视效应:缩写:TBC=颞骨胆脂瘤;IE=颅内表皮样瘤;EC=头颈部表皮包涵囊肿;DWI=弥散加权成像;ADC=表观弥散系数。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Diffusion Analysis of Intracranial Epidermoid, Head and Neck Epidermal Inclusion Cyst, and Temporal Bone Cholesteatoma.

Background and purpose: Intracranial epidermoid tumors, temporal bone cholesteatomas, and head and neck epidermoid inclusion cysts are typically slow-growing, benign conditions arising from ectodermal tissue. They exhibit increased signal on DWI. While much of the imaging literature describes these lesions as showing diffusion restriction, we aimed to investigate these qualitative signal intensities and interpretations of restricted diffusion with respect to normal brain structures. This study aimed to quantitatively evaluate the ADC values and histogram features of these lesions.

Materials and methods: This retrospective study included children with histologically confirmed diagnoses of intracranial epidermoid tumors, temporal bone cholesteatomas, or head and neck epidermoid inclusion cysts. Lesions were segmented, and voxelwise calculation of ADC values was performed along with histogram analysis. ADC calculations were validated with a second analysis software to ensure accuracy. Normal brain ROIs-including the cerebellum, white matter, and thalamus-served as normal comparators. Correlational analysis and Bland-Altman plots assessed agreement among software tools for ADC calculations. Differences in the distribution of values between the lesions and normal brain tissues were assessed using the Wilcoxon rank sum and Kruskal-Wallis tests.

Results: Forty-eight pathology-proved cases were included in this study. Among them, 13 (27.1%) patients had intracranial epidermoid tumors, 14 (29.2%) had head and neck epidermoid inclusion cysts, and 21 (43.7%) had temporal bone cholesteatomas. The mean age was 8.67 (SD, 5.30) years, and 27 (52.9%) were female. The intraclass correlation for absolute agreement for lesional ADC between the 2 software tools was 0.997 (95% CI, 0.995-0.998). The intracranial epidermoid tumor, head and neck epidermoid inclusion cyst, and temporal bone cholesteatoma median ADC values were not significantly different (973.7 versus 875.7 versus 933.2 ×10-6 mm2/s, P = .265). However, the ADCs of the 3 types of lesions were higher than those of 3 normal brain tissue types (933 versus 766, × 10-6 mm2/s, P < .0001).

Conclusions: The ADC values of intracranial epidermoid tumors, temporal bone cholesteatomas, and head and neck epidermoid inclusion cysts are higher than those of normal brain regions. It is not accurate to simply classify these lesions as exhibiting restricted diffusion or reduced diffusivity without considering the tissue used for comparison. The observed hyperintensity on DWI compared with the brain is likely attributable to a relatively higher contribution of the T2 shinethrough effect.

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