| Objective To study the value of apparent diffusion coefficient (ADC) in the classification of brain parenchyma tuberculosis together with its application value in the therapeutic efficacy evaluation.Methods Retrospective analysis was carried out for 128 patients finally diagnosed with brain parenchyma tuberculosis clinically or pathologically. All patients underwent brain MRI which scanning from the top of the head to the cerebellum. The scanning sequences include T1WI, T2WI, FLAIR, DWI and T1 enhancement. Characteristics of routine MRI images were observed. The average ADC values of the enhanced area in the lesion (homogeneous enhancing and ring-enhancing areas), non-enhancing area of the ring-enhancing center and edema zone around the lesion were measured, and ADC values of the normal brain white matter in contralaterally correspondent areas were also calculated. Self-control study was carried out between ADC values of pretreatment lesions in 52 patients with brain parenchyma tuberculosis and those obtained from rechecking three months later after treatment.Results Bain parenchy matuberculosis was classified as homogeneous-enhanced lesions and ring-enhanced lesions according to different enhancing ways.1. Significant differences (F= 2403.282, P< 0.05) were found between the average ADC values (0.87×10-3mm2/s,1.09×10-3mm2/s,0.63×10-3mm2/s, respectively) of enhanced area of homogeneous-enhanced lesions, edema zone around lesions and normal brain white matter area of contralaterally correspondent areas.2. Significant differences (F= 631.9, P< 0.05) were observed between the average ADC values (0.86×10-3mm2/s,1.01×10-3mm2/s,1.23×10-3mm2/s,0.64×10-3mm2/s, respectively) of non-enhanced areas in the ring-enhanced lesion center, ring-enhanced areas and normal brain white matter areas of contralaterally correspondent areas.3. Significant differences (t= 15.029, P< 0.05) were observed between the average ADC values of enhanced areas of homogeneous-enhanced and ring-enhanced lesions (0.87× 10-3mm2/s and 1.01×10-3mm2/s, respectively). Significant differences (t= 9.806, P< 0.05) were observed between the average ADC values of edema areas of the above two lesions (1.09×10-3mm2/s and 1.23×10-3mm2/s, respectively). Non-significant differences (t=1.747, P> 0.05) were found between the average ADC values of the opposite normal brain white matters of the above two lesions (0.63×10-3mm2/s and 0.64×10-3mm2/s, respectively).4. MRI was rechecked for 52 patients after three months of treatment, indicating there were 291 brain parenchyma lesions of which 83 of 193 homogenous-enhanced lesions were basically absorbed (43.0%),107 lesions were shrunk (55.4%) and 3 lesions were enlarged (1.6%); However, among 98 ring-enhanced lesions,24 lesions were basically absorbed (24.5%),72 lesions were shrunk (73.5%) and 2 lesions were enlarged (2.0%). Significant differences (t=7.722, P< 0.05) were found between ADC values of enhanced areas in homogenous-enhanced lesions before and after treatment (0.91×10-3mm2/s and 0.83× 10-3mm2/s, respectively). Significant differences (t= 8.631, P< 0.05) were observed between the average ADC values of edema areas (1.16×10-3mm2/s and 1.01×10-3mm2/s, respectively); No significant differences (t= 1.862, P> 0.05) were found in the average ADC values of the normal brain parenchyma (0.65×10-3mm2/s and 0.64×10-3mm2/s, respectively). Significant differences(t= 3.342, P< 0.05) were found in the average ADC values of the center of lesions in ring-enhanced lesions before and after treatment (0.87 x 10-3mm2/s and 0.81×10-3mm2/s, respectively); Significant differences (t=3.340,P< 0.05) were observed in the average ADC values of enhanced areas (1.01×10-3mm2/s and 0.95×10-3mm2/s, respectively); Significant differences (t= 8.783, P< 0.05) were observed in the average ADC values of edema zones (1.25×10-3mm2/s and 1.09×10-3mm2/s, respectively); No significant differences (t=1.5, P> 0.05) were found in the average ADC values of the normal brain parenchyma (0.64×10-3mm2/s and 0.64×10-3mm2/s, respectively).Conclusion 1. ADC values can accurately quantize and measure the degree of dispersion in different parts of the brain parenchyma tuberculosis, in combination with findings of routine MRI images which has values on the diagnosis of brain parenchyma.2. Measurement of ADC values of different areas of brain parenchyma tuberculosis lesions has an influence on typing of brain parenchyma tuberculosis, which can be used as supplement of description of MRI findings of brain parenchyma tuberculosis.3. After anti-tuberculosis treatment, ADC values of different areas of homogenous-enhanced and ring-enhanced brain parenchyma tuberculosis, and ADC value can be used as observational indicators of follow-up. |
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