Diagnostic accuracy of MRI compared to CCT in patients with brain metastases
Diagnostic accuracy of MRI compared to CCT in patients with brain metastases
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DOI：
10.1023/a:1006308808769
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发表时间：
1999-01-01
影响因子：
3.9
通讯作者：
Thron, A
中科院分区：
文献类型：
--
作者：
Schellinger, PD;Meinck, HM;Thron, A
目标。在颅外肿瘤患者中，脑转移（BM）的发生和数量对进一步的诊断方法和治疗策略以及患者的预后至关重要。虽然被广泛接受，但令人惊讶的是，文献中很少有证据表明MRI优于CCT。因此，在孤立性脑转移患者中，根据诊断性对比增强计算机断层扫描（CCT），我们研究了对比增强磁共振成像（MRI）可以获得哪些额外的信息。在55例CCT单发性脑转移患者中，17例MRI表现为多发脑转移（31%），38例同时表现为单发脑转移。根据我们数据的假定二项分布，我们计算出至少19%的CCT孤立性脑转移患者，其中MRI显示多发病变（p=0.05）。CCT遗漏的脑转移的两个主要特征是直径更小，比两种方式识别的脑转移平均小2厘米，以及更优先的额颞叶位置。MRI在诊断BM方面确实优于CCT，除了能发现较小病变外，更重要的原因是软组织造影剂效果更好，顺磁造影剂增强效果明显更强，没有骨伪影，局部体积效应较少，在三个不同平面上直接成像。因此，在BM患者的诊断检查中，MRI对于选择最佳治疗方法是必不可少的，特别是在决定是手术治疗还是主要对患者的转移灶进行放疗时。
Objectives. In patients with extracranial neoplasms, the occurrence and number of brain metastases (BM) are critical for further diagnostic approaches and therapeutic strategies and the patient's prognosis. Although widely accepted, there is surprisingly little evidence in the literature that MRI is superior to CCT. Therefore, in patients with solitary BM according to diagnostic contrast-enhanced computed tomography (CCT), we investigated, what additional information could be gained by contrast-enhanced magnetic resonance imaging (MRI).Methods/Results. Among 55 patients with solitary BM according to CCT, 17 had multiple BM on MRI (31%) and 38 had solitary BM in both. Based on a presumed binomial distribution of our data, we calculated a rate of at least 19% of patients with solitary BM on CCT, in which MRI would show multiple lesions (p=0.05). The two main characteristics for BM missed by CCT were the smaller diameter, which averages 2 cm less than in BM identified with both modalities, and a preferential frontotemporal location.Conclusion. MRI is indeed superior to CCT in the diagnosis of BM the essential reasons besides detection of smaller lesions being a better soft tissue contrast, significantly stronger enhancement with paramagnetic contrast agents, the lack of bone artifacts, fewer partial volume effects, and direct imaging in three different planes. Therefore, MRI is indispensable in the diagnostic workup of patients with BM for choosing the optimum therapeutic approach, especially with regard to the decision whether to operate or to primarily irradiate the patient's metastases.