全身扩散加权成像对多发性骨髓瘤化疗后疗效评估  

Whole-body diffusion weighted imaging for assessment of treatment response after chemotherapy in multiple myeloma

作　　者：王亚丽[1] 刘莹 王明 王冬梅[2] 赵保根 李玉清[1,2] WANG Yali;LIU Ying;WANG Ming;WANG Dongmei;ZHAO Baogen;LI Yuqing(CT/MRI Room,the Third Hospital of Hebei Medical University,Shijiazhuang 050051,China;Department of Radiology,the Afiliated Hospital of Hangzhou Normal University,Hangzhou 310015,China)

机构地区：[1]河北医科大学第三医院CT/MRI室,河北石家庄050051 [2]杭州师范大学附属医院放射科,浙江杭州310015

出　　处：《实用放射学杂志》2022年第9期1508-1512,共5页Journal of Practical Radiology

基　　金：河北省重点研发计划自筹项目(172777134);杭州市卫生科技局一般项目(20201203B218)。

摘　　要：目的 探讨全身扩散加权成像(WB-DWI)评估多发性骨髓瘤(MM)化疗疗效的价值.方法 选取经病理和血液学指标首次确诊的MM患者,于化疗前、化疗2个疗程及化疗4个疗程后分别行MR T1WI、T2WI及WB-DWI,测量不同病程时病灶的表观扩散系数(ADC)值,分析ADC值及其变化率与临床化验指标变化率的相关性.结果 共30例患者首次确诊MM,完成3次随访检查12例.骨髓瘤病灶在DWI图像表现为局限性或弥漫性高信号,ADC图像呈低信号.化疗2个疗程后,与首诊时比较,9例缓解、3例稳定.9例缓解病例中,DWI图像病变数目或范围减少或消失,信号强度降低或恢复正常;ADC值8例降低、1例升高.化疗4个疗程后,与化疗2个疗程时比较:9例缓解病例中2例进展、1例稳定、6例缓解.2例进展病例DWI图像出现髓外病变或骨骼病灶数目增多,ADC值升高;1例稳定病例DWI图像病变信号及范围基本相仿;6例缓解病例DWI图像上信号降低或范围减小或消失,ADC值5例降低、1例升高.3例稳定病例化疗4个疗程后均缓解,DWI图像上病变数目或范围减少或消失,信号降低或恢复正常,ADC值均略升高.化疗前ADC值与骨髓瘤细胞百分比呈正相关,与血清M蛋白呈负相关.化疗前、后ADC值变化率与血清免疫球蛋白、轻链及血β2微球蛋白变化率存在一定相关性.结论 WB-DWI结合ADC值评估MM化疗疗效具有可行性,可实时监测各个病灶的活动性及对化疗的反应,亦可用于MM短期及长期疗效评估.Objective To investigate the value of whole-body diffusion weighted imaging(WB-DWI)in evaluating chemotherapy efficacy of multiple myeloma(MM).Methods Patients fistly diagnosed MM by pathological and hematologic indicators underwent MR T,WI,T,WI and WB-DWI examinations before chemotherapy and after 2 and 4 courses of chemotherapy,respectively.Apparent diffusion coefficient(ADC)values of the lesions at each course were measured.The correlation between the change rate of ADC values and the clinical laboratory indexes were analyzed.Results 30 patients had firstly diagnosed MM,12 patients completed three follow-up examinations.Myeloma lesions showed localized or diffuse high signal intensity on DWI and low signal intensity on ADC images.After 2 courses of chemotherapy,9 cases were remission and 3 cases were stable compared with the first diagnosis.In 9 remission cases,the number or range of lesions on DWI images decreased or disappeared,and the signal intensity decreased or returned to normal.ADC value decreased in 8 cases and increased in 1 case.After 4 courses of chemotherapy,compared with 2 courses of chemotherapy,2 of 9 remission cases progressed,1 case was stable,and 6 cases were remission.The number of extramedullary lesions or bone lesions on DWI images of 2 advanced cases increased,and the ADC value increased.The lesion signal and range of DWI images of 1 stable case were basically similar.In 6 remission cases,the signal on DWI image decreased or the range decreased or disappeared,and ADC value decreased in 5 cases and increased in 1 case.After 4 courses of chemotherapy,all the 3 stable cases showed remission.Among them,the number or range of lesions on DWI images decreased or disappeared,the signal decreased or returned to normal,and the ADC value increased slightly.The ADC value was positively cor-related with the percentage of myeloma cells and negatively correla-ted with serum M protein before chemotherapy.There was a certain correlation between the change rate of ADC value and serum hemoimmunoglobulin,li

关 键 词：多发性骨髓瘤 全身扩散加权成像 表观扩散系数 化疗效果 

分 类 号：R733.3[医药卫生—肿瘤] R445.2[医药卫生—临床医学] R818.051