动态对比增强MRI对脊柱骨髓瘤和原发非霍奇金淋巴瘤的鉴别诊断  

Dynamic Contrast-enhanced MRI in Differential Diagnosis of Spinal Myeloma and Primary Non-Hodgkin Lymphoma

作　　者：郎宁[1] 张恩龙 苏敏英 袁慧书[1] LANG Ning;ZHANG Enlong;SU Minying;YUAN Huishu(Department of Radiology,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院放射科,北京100191 [2]北京大学国际医院放射科,北京102206 [3]加利福尼亚大学欧文分校肿瘤功能成像中心,美国加利福尼亚95101

出　　处：《中国医学影像学杂志》2018年第2期135-139,共5页Chinese Journal of Medical Imaging

基　　金：国家自然科学基金(81701648;81471634);北京市自然科学基金(7164309)

摘　　要：目的探讨动态对比增强MRI对脊柱浆细胞骨髓瘤(PCM)、骨的孤立性浆细胞瘤(SPB)和骨的原发性非霍奇金淋巴瘤(PNHLB)的鉴别诊断价值。资料与方法对病理证实的11例PCM、12例SPB和13例PNHLB做动态对比增强MRI,比较各组信号强度-时间曲线类型、曲线最大上升线性斜率(Max Wash-in SE%)、曲线下降斜率(Wash-out SE%)及增强曲线下的初始面积(IAUC)等。结果 11例PCM和12例SPB均为速降型曲线,1例PNHLB为速降型曲线,12例PNHLB为平台型曲线。PCM和SPB的Max Wash-in SE%、Wash-out SE%、IAUC差异均无统计学意义(P>0.05)。其中,以Wash-out SE%、Max Wash-in SE%、IAUC分别为21.38%、148%、2.47作为诊断骨髓瘤(包括PCM和SPB)和PNHLB的阈值时,诊断敏感度、特异度分别为95.7%、84.6%;69.6%、69.2%;73.9%、76.9%。受试者工作特性(ROC)曲线分析Wash-out SE%、Max Wash-in SE%、IAUC诊断骨髓瘤的曲线下面积分别为0.886、0.763、0.756。结论动态对比增强MRI可为脊柱造血系统肿瘤的鉴别诊断提供参考。Purpose To explore the value of dynamic contrast-enhanced MRI in differential diagnosis of spinal plasma cell myeloma（PCM）, solitary plasmacytoma of bone（SPB） and primary non-Hodgkin lymphoma of bone（PNHLB）. Materials and Methods Eleven PCM, 12 SPB and 13 PNHLB confirmed by pathology received dynamic contrast-enhanced MRI. Signal intensity-time curve, the steepest wash-in SE% during the ascending phase（Max Wash-in SE%）, the wash-out SE% and the initial area under enhanced curve（IAUC） and other parameters were compared. Results Both 11 PCM and 12 SPB showed the wash-out pattern. One PNHLB was the wash-out pattern and 12 PNHLB were the plateau pattern. Difference of Max Wash-in SE%, Wash-out SE% and IAUC of PCM and SPB was of no statistical significance（P〈0.05）, among which sensitivity and specificity of diagnosis were 95.7% and 84.6%, 69.6% and69.2%, 73.9% and 76.9% respectively when taking 21.38% Wash-out SE%, 148% Max Wash-in SE% and 2.47 IAUC as the threshold value for diagnosing myeloma（including PCM and SPB） and PNHLB. The area under curve of Wash-out SE%, Max Wash-in SE% and IAUC when diagnosing myeloma was 0.886, 0.763 and 0.756 respectively according to ROC analysis. Conclusion Dynamic contrast-enhanced MRI can provide reference for the differential diagnosis of spinal hematopoietic neoplasms.

关 键 词：多发性骨髓瘤 浆细胞瘤 淋巴瘤 非霍奇金 脊柱 磁共振成像 图像增强 诊断 鉴别 

分 类 号：R445[医药卫生—影像医学与核医学] R738.1[医药卫生—诊断学]