MR全身扩散加权成像评估多发性骨髓瘤不同骨髓浸润模式  

Assessment of different bone marrow infiltration patterns with MR whole-body diffusion weighted imaging in multiple myeloma

作　　者：吴雅雯 王冬梅[1] 曹宏伟[2] 崔凤珍[3] 徐成元 刘杰[1] 金成宇[1] 李博怡 李玉清 WU Yawen;WANG Dongmei;CAO Hongwei;CUI Fengzhen;XU Chengyuan;LIU Jie;JIN Chengyu;LI Boyi;LI Yuqing(Department of Radiology,the Affiliated Hospital of Hangzhou Normal University,Hangzhou 310015,China;Department of Radiology,the Affiliated Hospital of Chengde Medical College,Chengde,Hebei Province 067000,China;Department of Radiology,Shijiazhuang City Second Hospital,Shijiazhuang 050051,China;CT/MRI Room,the Third Hospital of Hebei Medical University,Shijiazhuang 050051,China)

机构地区：[1]杭州师范大学附属医院放射科,浙江杭州310015 [2]承德医学院附属医院放射科,河北承德067000 [3]石家庄市第二医院影像科,河北石家庄050051 [4]河北医科大学第三医院CT/MRI室,河北石家庄050051

出　　处：《实用放射学杂志》2024年第6期952-956,共5页Journal of Practical Radiology

基　　金：杭州市农业与社会发展科研项目(20201ZDSJ0780)。

摘　　要：目的采用MR全身扩散加权成像(WB-DWI)评估多发性骨髓瘤(MM)患者不同骨髓浸润模式的表观扩散系数(ADC)值,并确定区分不同骨髓浸润模式的ADC阈值。方法选取首次确诊的MM患者19例,WB-DWI检查的图像经视觉评估后,将各部位(颈椎、肋骨、胸骨、肱骨、肩胛骨、骶椎、髂骨、股骨、胸椎、腰椎)病灶类型分为局灶组(包括混合型中局灶病变)[感兴趣区(ROI)141个]、弥漫组(ROI 150个)、混合型中弥漫病变组(ROI 127个)、“盐和胡椒”组(ROI 54个)、正常组(ROI 68个),测量并比较各部位的ADC值,绘制ADC值区分不同骨髓浸润模式的受试者工作特征(ROC)曲线。结果混合型中弥漫病变组与“盐和胡椒”组ADC值差异无统计学意义(P>0.99),其余组间ADC值差异均有统计学意义(P<0.05)。ROC曲线显示,鉴别局灶组及“盐和胡椒”组骨髓浸润的曲线下面积(AUC)为0.889[95%置信区间(CI)0.844~0.934],鉴别弥漫组及正常组骨髓浸润的AUC为0.968(95%CI 0.949~0.987),ADC值能够准确、直观地区分不同骨髓浸润模式。结论ADC值能够作为量化工具,客观地区分MM患者不同骨髓浸润模式。Objective To evaluate the apparent diffusion coefficient(ADC)values of different bone marrow infiltration patterns in multiple myeloma(MM)patients with MR whole-body diffusion weighted imaging(WB-DWI)and to determine the ADC thresholds for different bone marrow infiltration patterns.Methods Nineteen MM patients diagnosed for the first time were selected.The lesions types of each site(cervical spine,ribs,sternum,humerus,scapula,sacral spine,ilium,femur,thoracic spine,and lumbar spine)after the WB-DWI images were visually evaluated,which were divided into focal group(including focal lesion in combined focal and diffuse infiltration)[region of interest(ROI)=141],pure diffuse infiltration group(ROI=150),diffuse lesion in combined focal and diffuse infiltration group(ROI=127),“salt-and-pepper”group(ROI=54),and normal appearance group(ROI=68).ADC values were measured and compared between each group and the receiver operating characteristic(ROC)curve was drawn to distinguish different patterns of bone marrow infiltration.Results There was no statistically significant difference in ADC values between the diffuse lesion in combined focal and diffuse infiltration group and the“salt-and-pepper”group(P>0.99),and there was statistically significant difference in ADC values between the other groups(P<0.05).The ROC curve showed that the area under the curve(AUC)for identifying focal group and the“salt-and-pepper”group was 0.889[95%confidence interval(CI)0.844-0.934],the AUC for identifying pure diffuse infiltration group and the normal appearance group was 0.968(95%CI 0.949-0.987).ADC values were able to accurately and visually differentiate between the different patterns of bone marrow infiltration.Conclusion The ADC values can be used as a quantitative tool to objectively distinguish different bone marrow infiltration patterns in MM patients.

关 键 词：多发性骨髓瘤 磁共振成像 全身扩散加权成像 骨髓浸润 

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