健康成人皮下注射重组人粒细胞集落刺激因子后骨髓变化的MRI表现  

MRI manifestations of bone marrow changes after recombinant human granulocyte colony stimulating factor was subcutaneous injected for healthy adults

作　　者：宋英儒[1] 李国[1] 叶伟[1] 黄仲奎[1] 龙莉玲[1] 章忠明[1] 马劼[1] 罗军[1] 

机构地区：[1]广西医科大学第一附属医院放射科,南宁530027

出　　处：《中华放射学杂志》2011年第9期812-816,共5页Chinese Journal of Radiology

基　　金：广西科学技术厅资助项目（桂科回0639024）

摘　　要：目的探讨健康成人受重组人粒细胞集落刺激因子（rhG—CSF）注射前后腰椎和股骨近端骨髓MRI的变化特点。方法对20名健康成人干细胞捐献者行SET1WI及T2WI－脂肪抑制序列，分别在皮下注射rhG—CSF前，注射后近期（4～7d）、注射后中远期（30～60d，10名）行腰椎矢状面、股骨中上段骨髓正冠状面MRI，研究和总结各时间段腰椎和股骨近端骨髓变化的特点。对比度信噪比（CNR）组间比较采用秩和检验。结果正常对照组骨髓像设为注射前腰椎、股骨近端骨髓MRI。20名rhG—CSF注射后近期组SET1WI腰椎骨髓信号呈均匀降低，同时椎体内带状、片状高信号的脂肪成分明显减少，股骨近端转子间及下方见条带状或小片状等或稍低信号灶，T2WI－脂肪抑制序列骨髓呈等或稍高信号，同一捐献者腰椎、股骨近端骨髓MRI异常信号灶同时出现。10名中远期组腰椎骨髓MRI与20名注射前组对比大致相同，而与注射后近期组对比，异常信号灶已基本恢复到注射前水平；但股骨近端骨髓MRI注射后中远期组与注射前组对比可见异常信号，表现为对称性带状或大片状SET1WI等或稍低信号灶，T2WI－脂肪抑制序列呈等或稍高信号，而与注射后近期组对比，异常信号灶可见向远端延伸、扩展现象。20名rhG—CSF注射前组CNR为114．11±15．11，近期组为71．04±12．25，10名注射后中远期组为91．64±11．68，注射前组与注射后近期组比较差异有统计学意义（P〈0．05），注射前组与注射后中远期组、注射后近期组与注射后中远期组CNR分别比较，差异均无统计学意义（P值均〉0．05）。结论注射rhG—CSF后，MRI可显示注射后近期骨髓内造血细胞和脂肪成分的变化，可为临床或骨髓移植提供骨髓变化时间与程度的无创性信息。Objective To investigate MRI manifestations of lumbar and proximal femoral bone marrow changes before and after recombinant human granulocyte colony stimulating factor （rhG-CSF） was subcutaneous injected for healthy adults. Methods Twenty healthy blood stem cell donors without hematologic disease were enrolled in this study. All of them underwent lumbar sagittal and proximal femur coronal MRI examination with spin echo T1WI and fat-suppressed T2WI. The first examination were performed before subcutaneous injection of rhG-CSF for comparison. In 4-7 days and 30-60 days after injection, the other two examinations were performed. The signal changes of lumbar and proximal femoral bone marrow were investigated by reading pictures and calculating the contrasted noise ratio （ CNR ） . Results Before rhG-CSF injection, all patients presented normal signal intensity of bone marrow. In 4- 7 days after injection, all the 20 cases presented homogeneous signal decrease in lumbar vertebral bodys on T1WI, accompanied by reduced fatty signal. In proximal femur, patchy or stripped hypointensity areas were found in intertrochanteric and subtrochanteric areas on T1WI. On fat-suppressed T2WI images, the signal of lumbar and proximal femoral bone marrow changed to equal or slightly-high signal intensity. In all cases, abnormal signal areas presented in lumbar and proximal femoral bone marrow occurred simultaneously in the same case. In the 10 cases received the third MRI during 30-60 days after rhG-CSF injection, signal intensity of lumbar bone marrow turned to normal in all sequence, but abnormal signal intensity areas were still existed and extended to distal part in femoral bone marrow, which appeared as symmetric stripped or patchy equal or slightly-low signal intensity on T1WI and equal or slightly-high signal intensity on T2WI. The CNR of lumbar bone marrow to subcutaneous fat before rhG-CSF injection, in 4-7 days and 30-60 days after rhG-CSF injection were 114. 11 ± 15.11, 71.04 ± 12. 25 and 91.64 ±11.68, respectively

关 键 词：干细胞移植 骨髓 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学]