多模态全身MRI检查对POEMS综合征骨损伤的诊断价值比较  

Comparison of Diagnostic Value of Multimodal Whole Body MRI in Bone Injury of POEMS Syndrome

作　　者：孙梦恬[1] 程敬亮[1] 张勇[1] 孟云[1] 李胤桦 张素平[2] SUN Mengtian;CHENG Jingliang;ZHANG Yong(Department of Magnetic Resonance,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,P.R.China)

机构地区：[1]郑州大学第一附属医院磁共振科,450052 [2]郑州大学第一附属医院血液科,450052

出　　处：《临床放射学杂志》2021年第1期122-126,共5页Journal of Clinical Radiology

基　　金：2019年河南省医学科技攻关计划(联合共建)项目(编号:LHGJ20190160)。

摘　　要：目的分析POEMS综合征患者骨损伤的多模态全身MRI表现,探讨全身MRI在POEMS综合征临床诊断方面的应用价值。方法搜集2012年8月至2019年8月经临床证实的15例POEMS综合征患者,男11例,女4例,年龄39~68岁,平均(50.1±8.8)岁。所有患者确诊前均进行包括全身T1WI序列、全身短时间反转恢复(STIR)序列以及全身扩散加权成像(DWIBS)在内的全身MRI检查,分别对三种序列图像进行观察,确定有无POEMS综合征骨损伤并记录病灶分布及数量。以病理活检或常规CT检查为金标准,计算三种全身MRI检查序列诊断POEMS综合征骨损伤的灵敏度、特异度、受试者工作特征曲线(ROC)曲线下面积(AUC)并进行对比。结果全身T1WI、全身STIR序列以及DWIBS诊断POEMS综合征骨损伤的灵敏度分别为88%、64%和56%,特异度分别为100%、100%和95%。全身T1WI灵敏度明显高于DWIBS(P<0.0001),全身T1WI灵敏度高于全身STIR(P=0.0012),全身STIR、DWIBS两者之间的灵敏度差异无统计学意义(P>0.05)。全身T1WI、全身STIR特异度均高于DWIBS(P=0.0294)。全身T1WI、全身STIR、DWIBS评价POEMS综合征骨损伤的AUC分别为0.9394、0.8182、0.7570,全身T1WI与全身STIR的AUC差异有统计学意义(P<0.0001),全身T1WI与DWIBS的AUC差异有统计学意义(P<0.0001),全身STIR与DWIBS的AUC差异有统计学意义(P=0.0012)。结论多模态全身MRI检查有利于对POEMS综合征患者多系统受累情况进行全面显示,全身T1WI、全身STIR以及DWIBS序列可明确POEMS综合征骨损伤的分布以及有无活性成分,具有较好的临床应用价值。Objective To analyze the multimodal wholebody MRI manifestations of bone injury in patients with POEMS syndrome, and to explore the application value of wholebody MRI in the clinical diagnosis of POEMS syndrome. Methods From August 2012 to August 2019,15 patients with POEMS syndrome, 11 males and 4 females, aged 39-68 years, with an average age of(50.1±8.8) years, were collected.All patients underwent whole-body MRI including whole-body T1WI sequence, whole-body STIR sequence and DWIBS before diagnosis.Three sequence images were observed to determine whether there was bone injury of POEMS syndrome and to record the distribution and number of lesions.Using pathological biopsy or conventional CT as gold standard, thesensitivity, specificity and area under ROC curve were calculated and compared. Results The sensitivity, specificity of whole body T1WI,whole body STIR and DWIBS were 88%,64%,56% and 100%,100%,95%,respectively.The sensitivity of whole body T1WI was significantly higher than that of DWIBS(P<0.0001),and was higher than that of whole body STIR(P=0.0012).There was no significant difference between whole body STIR and DWIBS(P>0.05).The specificity ofwhole body T1WI and STIR was higher than that of DWIBS(P=0.0294).The area under ROC curve ofwhole body T1WI,whole body STIR and DWIBS was0.9394,0.8182 and 0.7570,respectively.There was significant difference between whole body T1WI and whole body STIR(P<0.0001).The area under ROC curve of whole body T1WI and DWIBS had significant difference(P< 0.0001).There was significant difference between whole body STIR and DWIBS(P=0.0012). Conclusion Multimodal whole body MRI is helpful in revealing the multisystem involvement of POEMS syndrome patients.Whole body T1WI,whole body STIR and DWIBSsequencecan determine the distribution of bone injury and the presence of active ingredients, had good clinical application value in POEMS syndrome.

关 键 词：POEMS综合征 骨损伤 多模态磁共振成像 全身扩散加权成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R681[医药卫生—诊断学]