Abstract: Objective: To explore application value of diffusion weighted imaging (DWI) in differential diagnosis of high-grade glioma and brain metastasis. Methods: 15 patients with high-grade glioma and 17 patients with single brain metastases confirmed by postoperative pathology were enrolled in this study. All the patients underwent routine craniocerebral MRI scan, enhancement scan and DWI. The apparent diffusion coeffecient (ADC) value of tumor parenchyma and peritumoral edema area, relative ratio of N-acetyl aspartate (NAA), choline (Cho) and creatine (Cr) in patients with high-grade gliomas and brain metastases were measured and compared. The receiver operating characteristic (ROC) curve was used to evaluate differential diagnosis value of DWI for high-grade glioma and brain metastases. Results: There was no significant difference in Cho/Cr, Cho/NAA, NAA/Cr and ADC value in tumor area between patients with high-grade glioma and single brain metastases (P>0.05). Compared with those in peritumoral edema area of single brain metastases, Cho/Cr and Cho/NAA were significantly higher in peritumoral edema area of high-grade glioma, while NAA/Cr and ADC values were significantly lower (P<0.05). The AUC, sensitivity and specificity of combined Cho/Cr, Cho/NAA, NAA/Cr and ADC value for differential diagnosis of high-grade gliomas and brain metastases were higher than those of singly application (P<0.05). Conclusions: The sensitivity and specificity of DWI are relatively higher for differential diagnosis of glioma and brain metastases, which is of relatively higher clinical application value.

Key words: Magnetic resonance diffusion-weighted imaging (DWI), High-grade glioma, Brain metastases

摘要： 目的 探讨磁共振扩散加权成像（DWI）鉴别诊断高级别脑胶质瘤、脑转移瘤的应用价值。方法 我院收治的术后病理检查确诊为高级别脑胶质瘤患者15例,单发脑转移瘤患者17例,所有患者均行颅脑常规MRI扫描、增强扫描,DWI。测量比较高级别脑胶质瘤和脑转移瘤患者瘤体区、瘤周水肿区的ADC值,以及N乙酰天门冬氨酸（NAA）、胆碱（Cho）、肌酸（Cr）的相对比值。采用受试者工作特征（ROC）曲线评价DWI鉴别诊断高级别脑胶质瘤、脑转移瘤的价值。结果 高级别脑胶质瘤和单发脑转移瘤患者瘤体区Cho/Cr、Cho/NAA、NAA/Cr值、ADC值无明显差异（P>0.05）;与单发脑转移瘤瘤周水肿区比较,高级别脑胶质瘤瘤周水肿区的Cho/Cr、Cho/NAA更高,NAA/Cr、ADC值更低,差异有统计学意义（P<0.05）。联合应用Cho/Cr、Cho/NAA、NAA/Cr、ADC值鉴别诊断高级别脑胶质瘤、脑转移瘤的ROC曲线下面积（AUC）、灵敏度、特异度均大于四者单独应用。结论 DWI鉴别诊断脑胶质瘤、脑转移瘤的灵敏度和特异度较高,具有较高的临床应用价值。

关键词: 磁共振扩散加权成像（DWI）, 高级别脑胶质瘤, 脑转移瘤