恶性血液病骨髓动态增强磁共振成像特征的初步研究  

Characteristics of bone marrow with dynamic contrast-enhanced MR imaging in patients with haematological malignancies:preliminary results

作　　者：张蕾[1] 杨振燕[1] Alex G Pitman 

机构地区：[1]同济大学附属同济医院放射科,上海2000065 [2]Medical Imaging Department,St Vincent's Hospital,University of Melbourne,Melbourne,VIC 3010,Australia

出　　处：《中华放射学杂志》2007年第3期269-273,共5页Chinese Journal of Radiology

摘　　要：目的探讨利用动态增强 MR 成像技术检测恶性血液病患者骨髓构成的变化,判定其骨髓浸润程度,以减少血液病患者治疗随访过程中穿刺活检的次数。方法 25例恶性血液病患者经动态增强 MRI(DCE-MR)及髂嵴穿刺活检,测定骨髓灌注的最大强化率(PER),最大强化斜率值(Slope_(max)),峰值时间(TTP),平均时间(MT),以及骨髓活检分析细胞构成、肿瘤分数(TF)。结果25例恶性血液病患者骨髓的 PER、Slope_(max)、TYP、MT 的中位值分别为0.27、0.21 s^(-1)、79.08 s、84.43 s。不同细胞构成(低、正常、高)骨髓的灌注特征性变量的中位数值分别为 PER(0.29、0.24、1.15)、Slope_(max)(0.20 s^(-1)、0.21 s^(-1)、1.28 s^(-1))、TTP(96.67 s、83.49 s、25.52 s)、MT(77.52 s,86.25 s,84.34 s)。肿瘤浸润组首次灌注值(PER 0.32,Slope_(max)0.28 s^(-1))高于肿瘤缓解组,(PER 0.20,Slope_(max)0.20 s^(-1)),而对比剂到达峰值时间(TIP 68.66 s)低于缓解组(TTP 85.85 s)。肿瘤浸润组与缓解组骨髓的 PER差异有统计学意义(P=0.02),而 Slope_(max)、TTP、MT 差异无统计学意义(P 值均>0.05)。PER(r=0.564,P=0.003)、Slope_(max)(r=0.478,P=0.016)、MT(r=0.186,P>0.05)与骨髓细胞构成状态(低、正常、高)呈正相关,而 TTP(r=-0.222)与骨髓细胞构成状态呈负相关。PER(r=0.561,P=0.004)、Slope_(max)(r=0.318,P=0.121)、MT(r=0.207,P>0.05)与 TF 呈正相关,而 TTP(r=-0.305,P>0.05)与 TF 呈负相关。结论动态增强 MR 成像能够监测恶性血液病骨髓肿瘤细胞浸润和细胞构成的变化。Objective To determine whether dynamic contrast-enhanced MR （DCE-MRI） can successfully predict the status of diffusely abnormal bone marrow, and so obviate some bone marrow biopsies done for this indication. Methods DCE-MRI was performed in 25 patients with proven or known haematological malignancies. Time-signal intensity curves （TIC） analysis was generated from the region of the iliac crest corresponding to the planned biopsy site. Enhancement characteristics were analyzed, including peak enhance ratio （PER）, maximum slope （Slopemax）, time to peak （TTP）, and mean time （MT）. The parameters of the marrow histology included cellularity and turnout fraction （TF）. Results The median of PER, Slopemax, TTP, and MT in bone marrow with haematological malignancies were 0. 27, 0. 21 s^-l , 79.08 s, and 84. 43 s, respectively. The median of DCE-MR variation in bone marrow for hypo-, normal, and hyper-, cellularity groups were PER （0.29, 0.24, 1.15）, Slopemax （0.20 s^-1, 0.21 s^-1, 1.28 s^-1）, TTP （96.67 s, 83.49 s, 25.52 s）, MT （77.52 s, 86.25 s, 84.34 s）, respectively. The median of PER, Slopemax, TTP, and MT in bone marrow for the tumor recurrence group and the remission group were 0. 32, 0. 28 s^-1 , 68. 66 s, 84. 34 s, and 0. 20, 0. 20 s^-1 , 85. 85 s, 84. 52 s, respectively. There was significant difference for mean PER value between the tumor recurrence group and the remission group （ P = 0. 02）. But there were no significant difference for mean Slopemax, TIP, and MT values between the tumor recurrence group and the remission group（ P 〉 0. 05 ）. A positive correlation was found between PER and cellularity （ r = 0. 564, P = 0. 003 ）, between Slopemax and cellularity （ r = 0. 478, P = 0. 016）, between MT and cellularity （r = 0. 186 ）. A negative correlation was found between TIP and cellularity （r = -0. 222）. A positive correlation was found between PER and TF （r = 0. 561, P = 0. 004 ） , between Slopemax and TF（r =0.318, P=0.121）, between MT

关 键 词：骨髓疾病 血液肿瘤 磁共振成像 

分 类 号：R733[医药卫生—肿瘤]