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Abstract：
OBJECTIVE: To explore the value of preoperative magnetic resonance imaging (MRI) characterization of intracranial solitary fibrous tumors (ISFT) and to evaluate the effectiveness of preoperative MRI features in predicting pathological grading.
METHODS: This retrospective analysis comprised the clinical and preoperative MRI characterization of 55 patients with ISFT in our hospital, including 27 grade II cases and 28 grade III cases confirmed by postoperative pathology. Variables included age, sex, tumor location, cross-midline status, signal characteristics of T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), T2-fluid-attenuated inversion recovery (T2-FLAIR), and diffusion‑weighted imaging (DWI), peritumoral edema, intralesional hemorrhage, focal necrosis/cystic degeneration, tumor empty vessel, maximum tumor diameter, maximum, minimum, and average values of apparent diffusion coefficient (ADCmax, ADCmin, and ADCmean), tumors enhancement mode, meningeal tail sign, skull invasion, cerebral parenchymal invasion, and venous sinus involvement. The independent samples t test or Mann-Whitney U test was performed to compare continuous data between the two groups, and the Pearson chi-squared test or Fisher\'s exact test was used to compare categorical data. In addition, bivariate logistic regression was performed to construct a comprehensive model, and receiver operating characteristic (ROC) curves were generated to calculate the areas under the curve (AUCs), thereby determining the value of each parameter in the differential diagnosis of grades II and III ISFT.
RESULTS: The mean age at onset was similar between patients with grades II and III ISFT (46.77 ± 14.66 years and 45.82 ± 12.07 years, respectively). The proportions of men among patients with grades II and III ISFT were slightly higher than those of female patients (male/female: 1.25 [15/12] and 1.33 [16/12], respectively). There were significant differences between grades II and III ISFT in the T2-FLAIR and DWI signal characteristics, maximum, minimum, and average values of the apparent diffusion coefficient (ADCmax, ADCmin, and ADCmean), tumor location, and skull invasion (P = 0.001, P = 0.018, P = 0.000, P = 0.000, P = 0.000, P = 0.010, and P = 0.032, respectively). However, no significant differences were noted between grades II and III ISFT in age, sex, cross-midline status, T1WI and T2WI signal characteristics, peritumoral edema, intralesional hemorrhage, focal necrosis/cystic degeneration, tumor empty vessel shadow, enhancement mode, meningeal tail sign, maximum tumor diameter, brain parenchyma invasion, or venous sinus involvement (all P > 0.05). Moreover, binary logistic regression analysis showed that the model accuracy was 89.1% when ADCmin was included in the regression equation. Moreover, ROC curve analysis showed that the AUC of ADCmin was 0.805 (0.688, 0.922), sensitivity was 74.1%, specificity was 75.0%, and the cutoff value was 672 mm2/s.
CONCLUSIONS: Grade III ISFT patients displayed more mixed T2-FLAIR signal characteristics and DWI signal characteristics than grade II patients, as shown by higher skull invasion and tumor mass collapse midline distribution and lower ADCmax, ADCmean, and ADCmin values. The ADCmin value was significant in the preoperative assignment of grades II and III ISFT, thereby contributing to enhanced accuracy in the imaging grading diagnosis of the disease.
METHODS: This retrospective analysis comprised the clinical and preoperative MRI characterization of 55 patients with ISFT in our hospital, including 27 grade II cases and 28 grade III cases confirmed by postoperative pathology. Variables included age, sex, tumor location, cross-midline status, signal characteristics of T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), T2-fluid-attenuated inversion recovery (T2-FLAIR), and diffusion‑weighted imaging (DWI), peritumoral edema, intralesional hemorrhage, focal necrosis/cystic degeneration, tumor empty vessel, maximum tumor diameter, maximum, minimum, and average values of apparent diffusion coefficient (ADCmax, ADCmin, and ADCmean), tumors enhancement mode, meningeal tail sign, skull invasion, cerebral parenchymal invasion, and venous sinus involvement. The independent samples t test or Mann-Whitney U test was performed to compare continuous data between the two groups, and the Pearson chi-squared test or Fisher\'s exact test was used to compare categorical data. In addition, bivariate logistic regression was performed to construct a comprehensive model, and receiver operating characteristic (ROC) curves were generated to calculate the areas under the curve (AUCs), thereby determining the value of each parameter in the differential diagnosis of grades II and III ISFT.
RESULTS: The mean age at onset was similar between patients with grades II and III ISFT (46.77 ± 14.66 years and 45.82 ± 12.07 years, respectively). The proportions of men among patients with grades II and III ISFT were slightly higher than those of female patients (male/female: 1.25 [15/12] and 1.33 [16/12], respectively). There were significant differences between grades II and III ISFT in the T2-FLAIR and DWI signal characteristics, maximum, minimum, and average values of the apparent diffusion coefficient (ADCmax, ADCmin, and ADCmean), tumor location, and skull invasion (P = 0.001, P = 0.018, P = 0.000, P = 0.000, P = 0.000, P = 0.010, and P = 0.032, respectively). However, no significant differences were noted between grades II and III ISFT in age, sex, cross-midline status, T1WI and T2WI signal characteristics, peritumoral edema, intralesional hemorrhage, focal necrosis/cystic degeneration, tumor empty vessel shadow, enhancement mode, meningeal tail sign, maximum tumor diameter, brain parenchyma invasion, or venous sinus involvement (all P > 0.05). Moreover, binary logistic regression analysis showed that the model accuracy was 89.1% when ADCmin was included in the regression equation. Moreover, ROC curve analysis showed that the AUC of ADCmin was 0.805 (0.688, 0.922), sensitivity was 74.1%, specificity was 75.0%, and the cutoff value was 672 mm2/s.
CONCLUSIONS: Grade III ISFT patients displayed more mixed T2-FLAIR signal characteristics and DWI signal characteristics than grade II patients, as shown by higher skull invasion and tumor mass collapse midline distribution and lower ADCmax, ADCmean, and ADCmin values. The ADCmin value was significant in the preoperative assignment of grades II and III ISFT, thereby contributing to enhanced accuracy in the imaging grading diagnosis of the disease.
摘要：
目的：探讨术前磁共振成像（MRI）对颅内孤立性纤维瘤（ISFT）的诊断价值，并评估术前MRI特征对病理分级的预测价值。
方法：本回顾性分析了我院55例ISFT患者的临床和术前MRI表现，其中经术后病理证实为II级27例,III级28例。变量包括年龄，性别,肿瘤位置,跨中线状态,T1加权成像(T1WI)的信号特性,T2加权成像(T2WI),T2-流体衰减反演恢复(T2-FLAIR),和弥散加权成像(DWI)，瘤周水肿，病灶内出血,局灶性坏死/囊性变性，肿瘤空血管，肿瘤最大直径,最大值,minimum,和表观扩散系数的平均值(ADCmax，ADCmin,和ADCmean)，肿瘤增强模式，脑膜尾征,头骨入侵,脑实质侵犯,静脉窦受累.采用独立样本t检验或Mann-WhitneyU检验比较两组间的连续性数据,采用Pearson卡方检验或Fisher精确检验比较分类数据。此外,进行双变量logistic回归构建综合模型，和受试者工作特征（ROC）曲线，以计算曲线下面积（AUC），从而确定II级和III级ISFT的鉴别诊断中每个参数的值。
结果：II级和III级ISFT患者的平均发病年龄相似（46.77±14.66岁和45.82±12.07岁，分别)。II级和III级ISFT患者中男性的比例略高于女性患者（男性/女性：1.25[15/12]和1.33[16/12]，分别)。在T2-FLAIR和DWI信号特征方面，II级和III级ISFT之间存在显着差异，最大值,minimum,和表观扩散系数的平均值(ADCmax，ADCmin,和ADCmean)，肿瘤位置,和颅骨侵犯（分别为P=0.001，P=0.018，P=0.000，P=0.000，P=0.000，P=0.010和P=0.032）。然而,II级和III级ISFT之间的年龄没有显着差异，性别,跨中线状态,T1WI和T2WI信号特性,瘤周水肿，病灶内出血,局灶性坏死/囊性变性，肿瘤空血管阴影，增强模式,脑膜尾征,肿瘤最大直径,脑实质侵入,或静脉窦受累(均P>0.05)。此外，二元logistic回归分析显示，当ADCmin纳入回归方程时，模型准确率为89.1%。此外，ROC曲线分析表明,ADCmin的AUC为0.805(0.688,0.922),灵敏度为74.1%，特异性为75.0%,截止值为672mm2/s。
结论：III级ISFT患者比II级患者表现出更多的混合T2-FLAIR信号特征和DWI信号特征，如更高的颅骨浸润和肿瘤肿块塌陷中线分布和更低的ADCmax所示，ADCmean,和ADCmin值。ADCmin值在II级和III级ISFT的术前分配中具有显著意义，从而有助于提高疾病的影像分级诊断的准确性。
方法：本回顾性分析了我院55例ISFT患者的临床和术前MRI表现，其中经术后病理证实为II级27例,III级28例。变量包括年龄，性别,肿瘤位置,跨中线状态,T1加权成像(T1WI)的信号特性,T2加权成像(T2WI),T2-流体衰减反演恢复(T2-FLAIR),和弥散加权成像(DWI)，瘤周水肿，病灶内出血,局灶性坏死/囊性变性，肿瘤空血管，肿瘤最大直径,最大值,minimum,和表观扩散系数的平均值(ADCmax，ADCmin,和ADCmean)，肿瘤增强模式，脑膜尾征,头骨入侵,脑实质侵犯,静脉窦受累.采用独立样本t检验或Mann-WhitneyU检验比较两组间的连续性数据,采用Pearson卡方检验或Fisher精确检验比较分类数据。此外,进行双变量logistic回归构建综合模型，和受试者工作特征（ROC）曲线，以计算曲线下面积（AUC），从而确定II级和III级ISFT的鉴别诊断中每个参数的值。
结果：II级和III级ISFT患者的平均发病年龄相似（46.77±14.66岁和45.82±12.07岁，分别)。II级和III级ISFT患者中男性的比例略高于女性患者（男性/女性：1.25[15/12]和1.33[16/12]，分别)。在T2-FLAIR和DWI信号特征方面，II级和III级ISFT之间存在显着差异，最大值,minimum,和表观扩散系数的平均值(ADCmax，ADCmin,和ADCmean)，肿瘤位置,和颅骨侵犯（分别为P=0.001，P=0.018，P=0.000，P=0.000，P=0.000，P=0.010和P=0.032）。然而,II级和III级ISFT之间的年龄没有显着差异，性别,跨中线状态,T1WI和T2WI信号特性,瘤周水肿，病灶内出血,局灶性坏死/囊性变性，肿瘤空血管阴影，增强模式,脑膜尾征,肿瘤最大直径,脑实质侵入,或静脉窦受累(均P>0.05)。此外，二元logistic回归分析显示，当ADCmin纳入回归方程时，模型准确率为89.1%。此外，ROC曲线分析表明,ADCmin的AUC为0.805(0.688,0.922),灵敏度为74.1%，特异性为75.0%,截止值为672mm2/s。
结论：III级ISFT患者比II级患者表现出更多的混合T2-FLAIR信号特征和DWI信号特征，如更高的颅骨浸润和肿瘤肿块塌陷中线分布和更低的ADCmax所示，ADCmean,和ADCmin值。ADCmin值在II级和III级ISFT的术前分配中具有显著意义，从而有助于提高疾病的影像分级诊断的准确性。
