腰椎多发性骨髓瘤MR弥散加权成像研究
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摘要
目的探讨腰椎多发性骨髓瘤的MRI表现,DWI序列在诊断腰椎多发性骨髓瘤中的价值并对FSE T2WI脂肪抑制前后SNR差值及ADC值定量分析。
方法搜集经临床骨髓穿刺确诊腰椎多发性骨髓瘤患者20例(病变组)及正常志愿者20例(对照组),分别于临床治疗前行腰椎矢状位FSE T1WI、FSE T2WI、脂肪抑制FSE T2WI(FS-FSE T2WI)及单次激发自旋回波—回波平面DWI(SS-SE-EPI-DWI)检查,分析不同类型腰椎多发性骨髓瘤的MRI表现,并对FSE T2WI脂肪抑制前后正常与病变椎体的SNR(signal noise ratio)差值和ADC(ApparaentDiffusion Coefficient)值进行比较。利用原始图像后处理重建病变椎体的ADC图,并观察其表现。
结果(1)常规MRI表现:正常型3例,占15%,MRI T1WI病灶表现为稍高信号,T2WI呈等信号;弥漫型、局灶型分别为5例、9例,占25%、45%,MRI表现为T1WI病灶呈弥漫性或结节状低信号,T2WI呈高信号或等信号;“椒盐型”3例,占15%,MRI表现为弥漫性黑白相间的点状或小颗粒状高、低混杂信号。以上各型FS-FSE T2WI上均呈高信号。在DWI上正常型呈均匀一致等信号;弥漫型整个椎体呈现高信号;局灶型呈现局部团块状高信号;椒盐型呈现散在结节状高信号。(2)SNR差值:在T2WI序列上,病变组病变椎体脂肪抑制前后SNR差值(2.99±3.91)明显低于正常对照组椎体(9.19±2.83),其间差别具有显著统计学意义(P＜0.01)。(3)ADC值:b=400s/mm~2及b=600s/mm~2时,病变组病变椎体(0.972±0.414、0.885±0.367)均比正常对照组椎体(0.503±0.272、0.494±0.273)ADC值高,其间差别具有显著统计学意义(P＜0.01)。95%可信区间显示两者之间有很大一部分重叠区域(0.12～1.73,0.01～0.83)。病变椎体及正常椎体在不同b值时ADC值间的差别没有统计学意义(P＞0.05)。
结论腰椎MM的SS-SE-EPI-DWI成像可以用于弥散效应的定量检测,由DWI像上测得的ADC值是鉴别MM椎体与正常椎体的可靠指标。
Objective To discuss the MRI features of the lumbar multiple myeloma(MM).To study diffusion-weighted imaging(DWI) on patients with lumbar multiple myeloma and evaluate the difference of signal noise ratio(SNR) and apparent diffusion coefficients (ADCs) in diagnosis.
Methods 20 patients with lumber MM(confinnde by clinic and pathology) and 20 controls were performed with sagittal SE T1WI,FSE T2WI,Fat saturation FSE T2WI (FS-FSE T2WI) and single-shot spin-echo echoplanar DWI(SS-SE-EPI-DWI), respectively.Analysis MRI features of different Types of MM.The difference of SNR on FSE T2WI and FS-FSE T2WI and ADCs of lumbar MM and normal vertebrae on DWI with different b values were analyzed.ADC maps were reconstructed and observed in patients with lumbar MM.
Results(1)Routine MRI appearance:The vertebral MM was classified into the following four types:Normal type accounted for 15%,in which the lesions were mild hyper-intensity on T1WI,iso-intensity on T2W1 and hypo-intensity on DWI.Diffuse type accounted for 25%,in which the lesions were diffuse hypo-intensity with clear border on T1WI,hyper-intensity with indistinct border or iso-intensity on T2WI and hyper-intensity on DWI.Localized type accounted for 45%,in which the lesions were multiple nodular or patchy hypo-intensity on T1WI,mild hyper-intensity or iso-intensity on T2WI and hyper-intensity on DWI."Salt with pepper"type accounted for 15%,in which the lesions were diffuse spot-like mixed hyper-,iso-and hypo-intensity.All lesions were hyper -intensity on FS-FSE T2W1.(2) SNR_(T2WI)-SNR_(FS-T2WI):On T2WI,SNR difference of bone marrow on FSE T2WI and FS-FSE T2WI of MM group(2.99±3.91) was significantly lower than the control group(9.19±2.83).(3)ADC:the ADCs of leisions and normal vertebra in control group were:b=400s/mm~2(0.972±0.414、0.885±0.367),b=600s/mm~2 (0.503±0.272、0.494±0.273).The former are significantly higher than the the latter(P＜0.01).The absolute values and the 95%CIs of these two entities showed substantial overlap.There were no difference in the ADCs of the same ROIs on DWI between different b values.
Conclusion SS-SE-EPI-DWI(single-shot spin-echo echoplanar imaging diffusion -weighted imaging) of the spine is feasible for quantitative analysis of diffusion effects, and the ADCs calculated from diffusion-weighted MR images is a reliable parameter with which to distinguish multiple myeloma from normal vertebrae.
方法搜集经临床骨髓穿刺确诊腰椎多发性骨髓瘤患者20例(病变组)及正常志愿者20例(对照组),分别于临床治疗前行腰椎矢状位FSE T1WI、FSE T2WI、脂肪抑制FSE T2WI(FS-FSE T2WI)及单次激发自旋回波—回波平面DWI(SS-SE-EPI-DWI)检查,分析不同类型腰椎多发性骨髓瘤的MRI表现,并对FSE T2WI脂肪抑制前后正常与病变椎体的SNR(signal noise ratio)差值和ADC(ApparaentDiffusion Coefficient)值进行比较。利用原始图像后处理重建病变椎体的ADC图,并观察其表现。
结果(1)常规MRI表现:正常型3例,占15%,MRI T1WI病灶表现为稍高信号,T2WI呈等信号;弥漫型、局灶型分别为5例、9例,占25%、45%,MRI表现为T1WI病灶呈弥漫性或结节状低信号,T2WI呈高信号或等信号;“椒盐型”3例,占15%,MRI表现为弥漫性黑白相间的点状或小颗粒状高、低混杂信号。以上各型FS-FSE T2WI上均呈高信号。在DWI上正常型呈均匀一致等信号;弥漫型整个椎体呈现高信号;局灶型呈现局部团块状高信号;椒盐型呈现散在结节状高信号。(2)SNR差值:在T2WI序列上,病变组病变椎体脂肪抑制前后SNR差值(2.99±3.91)明显低于正常对照组椎体(9.19±2.83),其间差别具有显著统计学意义(P＜0.01)。(3)ADC值:b=400s/mm~2及b=600s/mm~2时,病变组病变椎体(0.972±0.414、0.885±0.367)均比正常对照组椎体(0.503±0.272、0.494±0.273)ADC值高,其间差别具有显著统计学意义(P＜0.01)。95%可信区间显示两者之间有很大一部分重叠区域(0.12～1.73,0.01～0.83)。病变椎体及正常椎体在不同b值时ADC值间的差别没有统计学意义(P＞0.05)。
结论腰椎MM的SS-SE-EPI-DWI成像可以用于弥散效应的定量检测,由DWI像上测得的ADC值是鉴别MM椎体与正常椎体的可靠指标。
Objective To discuss the MRI features of the lumbar multiple myeloma(MM).To study diffusion-weighted imaging(DWI) on patients with lumbar multiple myeloma and evaluate the difference of signal noise ratio(SNR) and apparent diffusion coefficients (ADCs) in diagnosis.
Methods 20 patients with lumber MM(confinnde by clinic and pathology) and 20 controls were performed with sagittal SE T1WI,FSE T2WI,Fat saturation FSE T2WI (FS-FSE T2WI) and single-shot spin-echo echoplanar DWI(SS-SE-EPI-DWI), respectively.Analysis MRI features of different Types of MM.The difference of SNR on FSE T2WI and FS-FSE T2WI and ADCs of lumbar MM and normal vertebrae on DWI with different b values were analyzed.ADC maps were reconstructed and observed in patients with lumbar MM.
Results(1)Routine MRI appearance:The vertebral MM was classified into the following four types:Normal type accounted for 15%,in which the lesions were mild hyper-intensity on T1WI,iso-intensity on T2W1 and hypo-intensity on DWI.Diffuse type accounted for 25%,in which the lesions were diffuse hypo-intensity with clear border on T1WI,hyper-intensity with indistinct border or iso-intensity on T2WI and hyper-intensity on DWI.Localized type accounted for 45%,in which the lesions were multiple nodular or patchy hypo-intensity on T1WI,mild hyper-intensity or iso-intensity on T2WI and hyper-intensity on DWI."Salt with pepper"type accounted for 15%,in which the lesions were diffuse spot-like mixed hyper-,iso-and hypo-intensity.All lesions were hyper -intensity on FS-FSE T2W1.(2) SNR_(T2WI)-SNR_(FS-T2WI):On T2WI,SNR difference of bone marrow on FSE T2WI and FS-FSE T2WI of MM group(2.99±3.91) was significantly lower than the control group(9.19±2.83).(3)ADC:the ADCs of leisions and normal vertebra in control group were:b=400s/mm~2(0.972±0.414、0.885±0.367),b=600s/mm~2 (0.503±0.272、0.494±0.273).The former are significantly higher than the the latter(P＜0.01).The absolute values and the 95%CIs of these two entities showed substantial overlap.There were no difference in the ADCs of the same ROIs on DWI between different b values.
Conclusion SS-SE-EPI-DWI(single-shot spin-echo echoplanar imaging diffusion -weighted imaging) of the spine is feasible for quantitative analysis of diffusion effects, and the ADCs calculated from diffusion-weighted MR images is a reliable parameter with which to distinguish multiple myeloma from normal vertebrae.
引文
1.徐爱德.骨关节CT和MRI[M].济南:山东科学技术出版社,2002,80-90
2.Edgardo A,Athanasios F,Ronald W,et al.Multiple Myeloma:Clinical Review and Diagnostic Imaging.Radiology,2004,231:11-23
3.李亚林.多发骨髓瘤38例临床影像学分析[J].中国医学影像技术,2001,17(7):622
4.Stabler A,Baur A,Bartl R,et al.Contrast enhancement and quantitative signal analysis in MR imaging of multiple myeloma:assessment of focal and diffuse growth patterns in marrow correlated with biopsies and survival rates[J].AJR,1996,167(4):1029-1036
5.Andreas MH,Marcel OP,Jonathan N,et al.Vertebral Metastases:Assessment with Apparent Diffusion Coefficient[J].Radiology,2002,225:889-894
6.Baur A,Reiser MF.Diffusion-weighted imaging of the musculoskeletal system in humans.Skeletal Radiology,2000,29:555-562
7.向东,罗天友,吴景全,等.脊椎多发性骨髓瘤的MRI表现与鉴别诊断[J].重庆医科大学学报,2006,31(5):725-727
8.Le Bihan D.Differentiation of benign versus pathologic compression fracture with diffusion-weighted MR imaging:a closer step toward the "holy grail" of tissue characterization?Radiology,1998,207:305-307
9.Chan JHM,Peh WCG,Tsui EYK,et al.Acute vertebral body compression fractures:discrimiantion between benign and malignant causes using apparent diffusion coefficients.BJR,2002,75:207-214
10.Spuentrup E,Buecker A,Adam G,et al.Diffusion weighted MR imaging for differentiation of benign fracture edema and tumor infiltration of the vertebral body.AJR,2001,76:351-358
11.J.G.Raya,O.Dietrich,M.F.Reiser,et al.Techniques for diffusion-weighted imaging of bone marrow[J].EJR,2005,55:64-73
12.Baur A,Stable A,Brunning R,et al.Diffusion-weighted MR imaging of bone marrow:differentiation of benign versus pathologic compression fractures[J].Radiology,1998,207(2):349-356
13.Castillo M,Arbelaez A,Smith JK,et al.Diffusion-weighted MR imaging offers no advantage over routine noncontrast MR imaging in the detection of vertebral metastases[J].JNR,2000,21(5):948-953
14.Zhou XJ,Leeds NE,McKinnon GC.Characterization of benign and metastatic vertebral compression fractures with quantitative diffusion MR imaging[J].AJNR,2002,23(1):165-170
15.Bammer R,Andreas M,Hernet h,et al.Linescan diffusion imaging of the spine[J].AJNR,2003,24(1):5-12
16.Maeda M,Sakuma H,Maier SE,et al.Quantitative assessment of diffusion abnormalities in benign and malignant vertebral compression fractures by linescan diffusion-weighted imaging[J].AJR,2003,181(5):1203-1209
17.徐文坚,郝大鹏,徐爱德,等.腰椎溶骨型转移瘤MR扩散加权成像研究[J].中华放射学杂志,2006,6(40):621-626
18.Erik-Jan PV,Mario M,Erik MA,et al.Vertebra Disc Ratio as a Parameter for Bone Marrow Involvement and Its Application in Gaucher Disease[J].Journal of Computer Assisted Tomography,2002,26(5):843-848
1.徐爱德.骨关节CT和MRI[M].济南:山东科学技术出版社,2002:80-90
2.施庭芳,主编.磁共振造影于脊柱病变的应用.台北:台湾大学医学院,1999.1.1-8,41-43.201-208
3.吴振华,杨本强.MRI骨髓成像的临床意义及发展.引进国外医药技术与设备,1998,4:42-48
4.Flickinger FW,Sanal SM.Bone marrow MRI:Techniques and accuracy for detecting breast cancer metastases.Magn Resort Imaging,1994,12:829-835
5.Vogler JB,Murphy WA.Bone marrow imaging[J].Radiology,1988,168:679-693
6.Poulton TB,Murpgy WD,Duerk JL,et al.Bone marrow reconversion in adults who are smokers[J].AJR,1993,161:1217-1221
7.Hosten N,Schorner W,Neumann K,et al.MR imaging of bone marrow review of the literature and possible indication for contrast-enhanced studies[J].Advances MRI Contrast,1993,1:76
8.沈君等.常见血液病的骨髓磁共振成像.中国医学计算机成像杂志,2003,9:5
9.沈君,梁碧玲,陈健宁,等.骨髓异常的MRI及其临床应用.癌症,2001,10:263-68
10.张华等.多发性骨髓瘤的MRI表现.中国医学影像技术,1999,15:7
11.吴良浩.老年骨质疏松与恶性肿瘤患者椎体压缩性骨折的MRI鉴别诊断.中华老年医学杂志,2002,12(21):6
12.向东等.脊柱多发性骨髓瘤的MRI表现与鉴别诊断.重庆医科大学学报,2006,31:5
13.Baur A,Stable A,Brunning R,et al.Diffusion-weighted MR imaging of hone marrow:differentiation of benign versus pathologic compression fractures[J].Radiology,1998,207(2):349-356
14.Baur A,Reiser MF.Diffusion weighted imaging of the musculoskeletal system in humans[J].Skeletal Radiol,2000,29:555-562
15.Le Bihan D.Molecular diffusion nuclearmagnetic resonance imaging[J].Magn Reson Q,1991,7:1-30
16.Spuentrup E,Buecker A,Adam G,et al.Diffusion weighted MR imaging for differentiation of benign fracture edema and tumor infiltration of the vertebral body[J].AJR,2001,176:351-358
17.Le Bihan D.Differentiation of benign versus pathologic compression fractures with diffusion weighted MR imaging:a closer step toward the "holy grail" of tissue characterization[J].Radiology,1998,207:305-307
18. Ward R, Caruthers S, Yablon C, et al. Analysis of diffusion changes in posttraumatic bone marrow using navigator-corrected diffusion gradients[J].AJR,2000,174:731- 734
19. Nonomura Y, Yasumoto M,Yoshimura R, et al. Relationship between bone marrow cellularity and apparent diffusion coefficient[J]. J Magn Reson Imaging, 2001, 13:757-760
20.Kim YJ, Chang KH, Song IC,et al. Brain abscess and necrotic or Cystic brain tumor discrimination with signal intensity on diffusion weighted MR imaging[J].AJR,1998,171:1487-1490
21. Ballon D, Dyke J, Schwartz LH,et al. Characterization of disease status in magnetic resonance bone marrow scanning of leukemia[J]. In Procof ISM RM,2000, 8th Annual Meeting:2128
22. Yasumoto M, Nonomura Y, Yoshimura R, et al. MR detection ofiliac bone marrow involvement by malignant lymphoma with various MR sequences including diffusion weighted echo planar imaging[J]. Skeletal Radiology, 2002, 31:263-269
23.Chan JHM, Peh WCG, Tsui EYK, et al. Acute vertebral body compression fractures:discrimination between benign and malignant causes using apparent diffusion coefficients[J]. BJR, 2002, 75:207-214
2.Edgardo A,Athanasios F,Ronald W,et al.Multiple Myeloma:Clinical Review and Diagnostic Imaging.Radiology,2004,231:11-23
3.李亚林.多发骨髓瘤38例临床影像学分析[J].中国医学影像技术,2001,17(7):622
4.Stabler A,Baur A,Bartl R,et al.Contrast enhancement and quantitative signal analysis in MR imaging of multiple myeloma:assessment of focal and diffuse growth patterns in marrow correlated with biopsies and survival rates[J].AJR,1996,167(4):1029-1036
5.Andreas MH,Marcel OP,Jonathan N,et al.Vertebral Metastases:Assessment with Apparent Diffusion Coefficient[J].Radiology,2002,225:889-894
6.Baur A,Reiser MF.Diffusion-weighted imaging of the musculoskeletal system in humans.Skeletal Radiology,2000,29:555-562
7.向东,罗天友,吴景全,等.脊椎多发性骨髓瘤的MRI表现与鉴别诊断[J].重庆医科大学学报,2006,31(5):725-727
8.Le Bihan D.Differentiation of benign versus pathologic compression fracture with diffusion-weighted MR imaging:a closer step toward the "holy grail" of tissue characterization?Radiology,1998,207:305-307
9.Chan JHM,Peh WCG,Tsui EYK,et al.Acute vertebral body compression fractures:discrimiantion between benign and malignant causes using apparent diffusion coefficients.BJR,2002,75:207-214
10.Spuentrup E,Buecker A,Adam G,et al.Diffusion weighted MR imaging for differentiation of benign fracture edema and tumor infiltration of the vertebral body.AJR,2001,76:351-358
11.J.G.Raya,O.Dietrich,M.F.Reiser,et al.Techniques for diffusion-weighted imaging of bone marrow[J].EJR,2005,55:64-73
12.Baur A,Stable A,Brunning R,et al.Diffusion-weighted MR imaging of bone marrow:differentiation of benign versus pathologic compression fractures[J].Radiology,1998,207(2):349-356
13.Castillo M,Arbelaez A,Smith JK,et al.Diffusion-weighted MR imaging offers no advantage over routine noncontrast MR imaging in the detection of vertebral metastases[J].JNR,2000,21(5):948-953
14.Zhou XJ,Leeds NE,McKinnon GC.Characterization of benign and metastatic vertebral compression fractures with quantitative diffusion MR imaging[J].AJNR,2002,23(1):165-170
15.Bammer R,Andreas M,Hernet h,et al.Linescan diffusion imaging of the spine[J].AJNR,2003,24(1):5-12
16.Maeda M,Sakuma H,Maier SE,et al.Quantitative assessment of diffusion abnormalities in benign and malignant vertebral compression fractures by linescan diffusion-weighted imaging[J].AJR,2003,181(5):1203-1209
17.徐文坚,郝大鹏,徐爱德,等.腰椎溶骨型转移瘤MR扩散加权成像研究[J].中华放射学杂志,2006,6(40):621-626
18.Erik-Jan PV,Mario M,Erik MA,et al.Vertebra Disc Ratio as a Parameter for Bone Marrow Involvement and Its Application in Gaucher Disease[J].Journal of Computer Assisted Tomography,2002,26(5):843-848
1.徐爱德.骨关节CT和MRI[M].济南:山东科学技术出版社,2002:80-90
2.施庭芳,主编.磁共振造影于脊柱病变的应用.台北:台湾大学医学院,1999.1.1-8,41-43.201-208
3.吴振华,杨本强.MRI骨髓成像的临床意义及发展.引进国外医药技术与设备,1998,4:42-48
4.Flickinger FW,Sanal SM.Bone marrow MRI:Techniques and accuracy for detecting breast cancer metastases.Magn Resort Imaging,1994,12:829-835
5.Vogler JB,Murphy WA.Bone marrow imaging[J].Radiology,1988,168:679-693
6.Poulton TB,Murpgy WD,Duerk JL,et al.Bone marrow reconversion in adults who are smokers[J].AJR,1993,161:1217-1221
7.Hosten N,Schorner W,Neumann K,et al.MR imaging of bone marrow review of the literature and possible indication for contrast-enhanced studies[J].Advances MRI Contrast,1993,1:76
8.沈君等.常见血液病的骨髓磁共振成像.中国医学计算机成像杂志,2003,9:5
9.沈君,梁碧玲,陈健宁,等.骨髓异常的MRI及其临床应用.癌症,2001,10:263-68
10.张华等.多发性骨髓瘤的MRI表现.中国医学影像技术,1999,15:7
11.吴良浩.老年骨质疏松与恶性肿瘤患者椎体压缩性骨折的MRI鉴别诊断.中华老年医学杂志,2002,12(21):6
12.向东等.脊柱多发性骨髓瘤的MRI表现与鉴别诊断.重庆医科大学学报,2006,31:5
13.Baur A,Stable A,Brunning R,et al.Diffusion-weighted MR imaging of hone marrow:differentiation of benign versus pathologic compression fractures[J].Radiology,1998,207(2):349-356
14.Baur A,Reiser MF.Diffusion weighted imaging of the musculoskeletal system in humans[J].Skeletal Radiol,2000,29:555-562
15.Le Bihan D.Molecular diffusion nuclearmagnetic resonance imaging[J].Magn Reson Q,1991,7:1-30
16.Spuentrup E,Buecker A,Adam G,et al.Diffusion weighted MR imaging for differentiation of benign fracture edema and tumor infiltration of the vertebral body[J].AJR,2001,176:351-358
17.Le Bihan D.Differentiation of benign versus pathologic compression fractures with diffusion weighted MR imaging:a closer step toward the "holy grail" of tissue characterization[J].Radiology,1998,207:305-307
18. Ward R, Caruthers S, Yablon C, et al. Analysis of diffusion changes in posttraumatic bone marrow using navigator-corrected diffusion gradients[J].AJR,2000,174:731- 734
19. Nonomura Y, Yasumoto M,Yoshimura R, et al. Relationship between bone marrow cellularity and apparent diffusion coefficient[J]. J Magn Reson Imaging, 2001, 13:757-760
20.Kim YJ, Chang KH, Song IC,et al. Brain abscess and necrotic or Cystic brain tumor discrimination with signal intensity on diffusion weighted MR imaging[J].AJR,1998,171:1487-1490
21. Ballon D, Dyke J, Schwartz LH,et al. Characterization of disease status in magnetic resonance bone marrow scanning of leukemia[J]. In Procof ISM RM,2000, 8th Annual Meeting:2128
22. Yasumoto M, Nonomura Y, Yoshimura R, et al. MR detection ofiliac bone marrow involvement by malignant lymphoma with various MR sequences including diffusion weighted echo planar imaging[J]. Skeletal Radiology, 2002, 31:263-269
23.Chan JHM, Peh WCG, Tsui EYK, et al. Acute vertebral body compression fractures:discrimination between benign and malignant causes using apparent diffusion coefficients[J]. BJR, 2002, 75:207-214