Lei Niu, Jiping Zhao, Chongfeng Duan, Weiwei Fu, Yingchao Liu, Xuejun Liu, Shuangshuang Song
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Three separate institutional validation cohort (including 177 PCNSL and 177 glioma patients) was analyzed to validate the diagnostic performance of the \"purfling sign.\"</p><p><strong>Results: </strong>Among the test set, the inter-rater agreement of the \"purfling sign\" was high (κ = 0.907), while that for the other features was only good [κ = 0.663-0.691]. The purfling sign was present in 89 (55.28%) lymphoma and 13 (8.07%) glioma cases with a specificity of 91.93%, a sensitivity of 55.28%, a positive predictive value (PPV) of 87.25%, and a negative predictive value (NPV) of 67.27% for the diagnosis of PCNSL. Furthermore, the tumors presenting with the \"target sign\" were all PCNSL (16/16,100%), with a specificity and PPV of 100%. 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Inter-rater agreement was assessed with Cohen's kappa (κ), and the diagnostic performance of the \\\"purfling sign\\\" in identifying PCNSL was investigated. Three separate institutional validation cohort (including 177 PCNSL and 177 glioma patients) was analyzed to validate the diagnostic performance of the \\\"purfling sign.\\\"</p><p><strong>Results: </strong>Among the test set, the inter-rater agreement of the \\\"purfling sign\\\" was high (κ = 0.907), while that for the other features was only good [κ = 0.663-0.691]. The purfling sign was present in 89 (55.28%) lymphoma and 13 (8.07%) glioma cases with a specificity of 91.93%, a sensitivity of 55.28%, a positive predictive value (PPV) of 87.25%, and a negative predictive value (NPV) of 67.27% for the diagnosis of PCNSL. Furthermore, the tumors presenting with the \\\"target sign\\\" were all PCNSL (16/16,100%), with a specificity and PPV of 100%. 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引用次数: 0
摘要
目的:探讨原发性中枢神经系统淋巴瘤(primary central nervous system lymphoma, PCNSL)与脑胶质瘤的新型影像学标记“purfling sign”的鉴别价值及其在PCNSL术前鉴别中的价值。方法:由2名独立的神经放射学家对161例PCNSL和161例胶质瘤的磁共振增强成像特征进行评估:(1)是否存在“发光征象”;(2)病变灶有无坏死、囊性改变;(3)肿瘤实质增强的异质性。采用Cohen’s kappa (κ)评价评分间一致性,并探讨“purfling sign”对PCNSL的诊断作用。三个独立的机构验证队列(包括177例PCNSL和177例胶质瘤患者)进行了分析,以验证“紫色征象”的诊断性能。结果:在测试集中,“purfling sign”的评分一致性较高(κ = 0.907),而其他特征的评分一致性较好[κ = 0.663-0.691]。淋巴瘤89例(55.28%)、胶质瘤13例(8.07%)存在紫色征象,特异性为91.93%,敏感性为55.28%,阳性预测值(PPV)为87.25%,阴性预测值(NPV)为67.27%。出现“靶征”的肿瘤均为PCNSL(16/ 16100%),特异性和PPV均为100%。通过验证队列分析,85.09%的“purfling sign”阳性病例为PCNSL (p)。结论:我们的研究发现增强MR上的“purfling sign”代表了PCNSL术前诊断的高特异性影像学标记。这种无创标记物可能有助于指导PCNSL的临床诊断和治疗过程。
The "purfling sign": a new imaging marker for the diagnosis of primary CNS lymphoma.
Objectives: To investigate whether the "purfling sign," a new imaging marker, could distinguish primary central nervous system lymphoma (PCNSL) from brain gliomas, and its diagnosis value for preoperative identification of PCNSL.
Methods: Contrast-enhanced MR imaging features of 161 PCNSL and 161 glioma were evaluated by 2 independent neuroradiologists: (1) the presence/absence of the "purfling sign"; (2) the presence/absence of lesion necrosis and cystic changes; and (3) the heterogeneity of tumor parenchymal enhancement. Inter-rater agreement was assessed with Cohen's kappa (κ), and the diagnostic performance of the "purfling sign" in identifying PCNSL was investigated. Three separate institutional validation cohort (including 177 PCNSL and 177 glioma patients) was analyzed to validate the diagnostic performance of the "purfling sign."
Results: Among the test set, the inter-rater agreement of the "purfling sign" was high (κ = 0.907), while that for the other features was only good [κ = 0.663-0.691]. The purfling sign was present in 89 (55.28%) lymphoma and 13 (8.07%) glioma cases with a specificity of 91.93%, a sensitivity of 55.28%, a positive predictive value (PPV) of 87.25%, and a negative predictive value (NPV) of 67.27% for the diagnosis of PCNSL. Furthermore, the tumors presenting with the "target sign" were all PCNSL (16/16,100%), with a specificity and PPV of 100%. Analysis with the validation cohort, 85.09% cases with a positive "purfling sign" were PCNSL (p < 0.0001; PPV = 85.09%, NPV = 66.67%, specificity = 90.40%, sensitivity = 54.80%).
Conclusions: With a robust inter-rater agreement, our study found that the "purfling sign" on enhanced MR represents a high specific imaging marker for the preoperative diagnosis of PCNSL. This noninvasive marker may aid in the guidance of the clinical diagnosis and treatment processes of PCNSL.
期刊介绍:
Felice Perussia founded La radiologia medica in 1914. It is a peer-reviewed journal and serves as the official journal of the Italian Society of Medical and Interventional Radiology (SIRM). The primary purpose of the journal is to disseminate information related to Radiology, especially advancements in diagnostic imaging and related disciplines. La radiologia medica welcomes original research on both fundamental and clinical aspects of modern radiology, with a particular focus on diagnostic and interventional imaging techniques. It also covers topics such as radiotherapy, nuclear medicine, radiobiology, health physics, and artificial intelligence in the context of clinical implications. The journal includes various types of contributions such as original articles, review articles, editorials, short reports, and letters to the editor. With an esteemed Editorial Board and a selection of insightful reports, the journal is an indispensable resource for radiologists and professionals in related fields. Ultimately, La radiologia medica aims to serve as a platform for international collaboration and knowledge sharing within the radiological community.