对比增强FLAIR序列在颅内病变诊断中的定量评估:与T1加权增强成像的对照研究-东南大学学报医学版

对比增强FLAIR序列在颅内病变诊断中的定量评估:与T1加权增强成像的对照研究

单位：1. 南京市溧水区人民医院/东南大学附属中大医院溧水分院医学影像科, 江苏南京 211200;
2. 东南大学附属中大医院放射科, 江苏南京 210009

分类号：R445.2

出版年·卷·期（页码）：2026·45·第二期（236-245）

摘要：

目的:系统评估对比增强液体衰减反转恢复序列(CE-FLAIR)与对比增强T1 加权序列(CE-T1WI)对颅内病变的定量诊断效能差异。方法: 回顾性分析2023年4月至2024年9月南京市溧水区人民医院 392 例接受3.0 T 颅脑MRI增强检查患者的影像资料,所有病例均完成平扫(T1WI、T2WI、FLAIR)及增强(CE-T1WI、CE-FLAIR)序列扫描。使用 RadiAnt DICOM Viewer、ImageJ和3D Slicer软件定量分析脑实质、硬脑膜及柔脑膜病变特征。通过McNemar检验比较两种增强序列的病灶检出一致性;采用Wilcoxon非参数检验比较两种序列在图像信噪比(SNR)、对比噪声比(CNR)、病灶背景比(LBR)、强化百分比(PI)、净强化面积(NEA)和净增强信号强度(NSI)等参数的统计学差异。结果:CE-FLAIR总体检出率显著优于 CE-T1WI(96.68% vs. 86.22%, χ²=35.77,P<0.001)。定量分析显示,CE-FLAIR 的 CNR(82.57 vs.59.03,P<0.001)和 LBR(2.70 vs. 1.53,P<0.001)显著优于 CE-T1WI,但 SNR(134.07 vs. 176.07,P<0.001)和 PI(0.54 vs. 1.97,P<0.001)相对较低。分层分析显示,脑实质病变CE-FLAIR 的 NEA更大[90.50(34.64,201.25)mm² vs. 56.90(22.95,191.07)mm²,P<0.001];硬脑膜病变CE-T1WI 在 NEA[82.07(37.46,128.96)mm² vs. 55.71(31.18,112.61)mm²,P=0.001]和平均NSI[479.38(368.71,603.41)vs. 438.93(222.54,619.76),P=0.012]方面更优;柔脑膜病变CE-FLAIR 的 NEA[43.43(27.14,249.14)mm² vs. 34.00(13.43,61.14)mm²,P=0.033]、最大NSI[782.00(383.00,1 039.00)vs. 456.00(319.00,701.00),P=0.033]及 NSI标准差[147.84(65.73,212.23)vs. 56.90(47.00,114.01),P=0.013]更高。结论:CE-FLAIR可显著提升颅内病灶检出率,尤其在柔脑膜及脑实质病变范围界定方面优势显著,建议作为颅脑MRI增强检查的常规补充序列,具有重要的临床应用价值。

Objective: To compare the quantitative diagnostic performance of contrast-enhanced fluid-attenuated inversion recovery(CE-FLAIR) and contrast-enhanced T1-weighted imaging(CE-T1WI) in intracranial lesions. Methods: A retrospective analysis was conducted on imaging data from 392 patients who underwent 3.0T contrast-enhanced brain MRI at Lishui District People's Hospital of Nanjing between April 2023 and September 2024. All cases completed non-contrast sequences(T1WI, T2WI, FLAIR) and contrast-enhanced sequences(CE-T1WI, CE-FLAIR). Quantitative analysis of brain parenchymal, dural, and leptomeningeal lesion characteristics was performed using RadiAnt DICOM Viewer, ImageJ, and 3D Slicer software. McNemar's test was employed to compare the consistency of lesion detection between the two contrast-enhanced sequences, while the Wilcoxon non-parametric test was used to analyze statistical differences in parameters including signal-to-noise ratio(SNR), contrast-to-noise ratio(CNR), lesion-to-background ratio(LBR), percentage increase(PI), net enhancement area(NEA), and net signal intensity(NSI). Results: The overall detection rate of CE-FLAIR was significantly superior to that of CE-T1WI(96.68% vs. 86.22%, χ²=35.77, P<0.001). Quantitative analysis revealed that CE-FLAIR had significantly higher CNR(82.57 vs. 59.03, P<0.001) and LBR(2.70 vs. 1.53, P<0.001) compared to CE-T1WI, but lower SNR(134.07 vs. 176.07, P<0.001) and PI(0.54 vs. 1.97, P<0.001). Stratified analysis showed, for parenchymal lesions, CE-FLAIR demonstrated significantly larger NEA [90.50(34.64, 201.25) mm² vs. 56.90(22.95, 191.07) mm², P<0.001]; for dural lesions, CE-T1WI was superior in both NEA [82.07(37.46, 128.96) mm² vs. 55.71(31.18, 112.61) mm², P=0.001]and NSImean [479.38(368.71, 603.41) vs. 438.93(222.54, 619.76), P=0.012]; for leptomeningeal lesions, CE-FLAIR showed significantly higher NEA [43.43(27.14, 249.14) mm² vs. 34.00(13.43, 61.14) mm², P=0.033], maximum NSI [782.00(383.00, 1 039.00) vs. 456.00(319.00, 701.00), P=0.033], and standard deviation of NSI [147.84(65.73, 212.23) vs. 56.90(47.00, 114.01), P=0.013]. Conclusion: CE-FLAIR provides superior detection and delineation of intracranial lesions, particularly in leptomeningeal and parenchymal involvement, supporting its integration into routine contrast-enhanced MRI protocols.

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[9] ALONSO A,EISELE P,EBERT A D,et al.Leptomeningeal contrast enhancement and blood-CSF barrier dysfunction in aseptic meningitis[J].Neurol Neuroimmunol Neuroinflamm,2015,2(6):e164. CE-T1WI(A)和CE-FLAIR(B)序列可见双侧枕叶大小不等类圆形环状高信号,内部不均匀强化(箭头所示);C.T1WI减影图像显示病灶NEA值为600.952 mm²,NSI_min为174.333、NSI_max为1 554.667、NSI_mean为554.453、NSI_SD为245.667;D.FLAIR减影图像病灶NEA值为572.238 mm²,NSI_min为145.333、NSI_max为1531.333、NSI_mean为489.626、NSI_SD为202.520 图4 76岁男性食管癌术后脑内多发转移瘤患者的影像特征《东南大学学报(医学版)》简介《东南大学学报(医学版)》(以下简称本刊)前身为《南京铁道医学院学报》,随着南京铁道医学院与东南大学合并,原刊于2001年9月更改为现刊名。本刊是教育部主管、东南大学主办的国家级综合性医学学术期刊。主要刊登基础医学、临床医学、公共卫生与预防医学、中西医结合、药学等方面的研究成果及新技术新方法、病例报告、综述等,并以分子遗传、影像医学、心脏介入、急诊医学为办刊特色。本刊为中国科技论文统计源期刊,即中国科技核心期刊,多年来一直被美国《化学文摘》(CA)、俄罗斯《文摘杂志》(AJ)、波兰《哥白尼索引》(IC)、《中国核心期刊(遴选)数据库》《中国生物医学文献数据库》《中文生物医学期刊目次数据库》《中国学术期刊综合评价数据库》、中国期刊网、《中国学术期刊(光盘版)》《中文科技期刊数据库》《万方数据资源系统》《天元数据网》、中华首席医学网、教育阅读网等全文收录,同时被《中国药学文摘》《中国医学文摘》各分册收录。本刊为双月刊,国内外公开发行,邮发代号28-265,全国各地邮局均可订阅。定价:20元/册,120元/年。本刊热忱欢迎本校师生和校外医学科研人员投稿。本刊只接受网上投稿,非网上投稿稿件不能进入专家评审及后续流程。本刊唯一网上投稿网址为www.ddxbyxb.cn,有意投稿者请按提示逐项填写相关信息。请注意必须以第一作者的信息来填写,本刊将对作者信息予以保密。

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