年龄、性别与腰椎骨髓动态对比增强MR灌注参数的相关性

目的 探讨成人腰椎骨髓动态对比增强MR半定量灌注参数与年龄、性别的相关性.资料与方法 选择93例受检者进行动态对比增强MR灌注成像,小于50岁组(简称A组)46例,大于50岁组(简称B组)47例.分析峰值增强百分率(Emax)和增强斜率(ES)与年龄、性别的相关性.结果 A组的Emax、ES高于B组(P <0.05).在A组中,女性的Emax、ES高于男性(P <0.05);在B组中,女性和男性的Emax、ES差异无统计学意义(P >0.05).A组的女性的Emax、ES显著高于B组的女性(P <0.001),A组的男性与B组的男性的Emax、ES差异无统计学意义(P>0.05).女性的Emax、ES与年龄变化有负相关性(P <0.001),男性的Emax、ES与年龄变化的相关性不具有统计学意义(P >0.05).结论 动态对比增强MR半定量灌注参数可以用来评价正常腰椎骨髓血流灌注状态,年龄、性别与峰值增强百分率、增强斜率有相关性.     

动态对比增强MR灌注成像在脊椎骨髓病变诊断中的应用

基于钆对比剂首过效应的动态对比增强MR灌注成像可以用来评价脊椎骨髓的血流状态。就脊椎骨髓动态对比增强MR灌注成像原理、扫描技术、灌注参数分析及在正常脊椎骨髓、椎体良恶性压缩性骨折和脊椎骨髓弥漫性浸润性病变中的应用进展进行综述。     

动态增强MRI评价去势兔骨质疏松腰椎骨髓灌注:与BMD和MVD对照研究

目的用MR动态增强观察去势兔骨质疏松腰椎的骨髓灌注变化,并与骨密度(BMD)、免疫组织化学对照。材料与方法新西兰大白兔22只,随机分为2组(实验组12只,对照组10只)。双侧卵巢切除术后3、5、7个月分别行动态增强MRI和双能X线吸收测量法(DEXA)检测腰椎骨髓灌注的最大增强百分比(Emax)、增强斜率(ES)和BMD,并与组织的微血管密度(MVD)对照。结果双侧卵巢切除去势法(OVX)组兔在术后7个月时腰椎BMD与对照组相比明显降低(P<0.05)。术后3个月和5个月两组间腰椎的Emax和ES值均无明显差异(P>0.05);术后第7个月OVX组腰椎的灌注较对照组明显下降,Emax和ES值均明显降低(P<0.05);对照组腰椎骨髓MVD计数平均为67.58±11.6;而OVX组的MVD计数为39.32±9.54,明显少于对照组(P<0.05)。OVX组兔术后7个月腰椎动态增强MRI的Emax、ES和组织的MVD呈正相关(r分别为0.866和0.771,P<0.05);Emax、ES和腰椎BMD之间亦有明显的正相关性(r分别为0.714和0.820,P<0.05)。结论去势兔骨质疏松后腰椎骨髓的血液灌注明显下...     

动态对比增强MR灌注成像在脊椎骨髓病变诊断中的应用

基于钆对比剂首过效应的动态对比增强MR灌注成像可以用来评价脊椎骨髓的血流状态.就脊椎骨髓动态对比增强MR灌注成像原理、扫描技术、灌注参数分析及在正常脊椎骨髓、椎体良恶性压缩性骨折和脊椎骨髓弥漫性浸润性病变中的应用进展进行综述.     

MR化学位移成像对血液病骨髓监测的初步研究

目的:本文旨在研究MR化学位移成像技术与血液病治疗中骨髓的细胞构成变化的相关性.材料和方法:35例确诊的恶性血液病病人通过MR化学位移成像及髂嵴穿刺活检进行对照分析,测定骨髓化学位移率(CSR)、细胞构成变化和肿瘤浸润分数(TF).同期30例无血液系统疾病病人进行了髂骨的化学位移成像及CSR测定,对血液病组和对照组分别进行定量均值计算及相关分析.结果:血液病组CSR为0.696±0.236,对照组CSR为0.422±0.159,血液病组与对照组间CSR的差异有统计学意义(P＜0.01).不同细胞构成比和不同TF的骨髓CSR组间差异显著(P＜0.001).Kendall等级相关提示CSR与细胞构成比、TF呈明显相关(P＜0.01).结论:MR化学位移成像能够监测血液病治疗后骨髓细胞构成的变化以及是否仍然存在肿瘤浸润.     

动态增强MR成像对骨髓构成变化监测的初步研究

目的:研究动态增强MR成像(DCE-MRI)技术与血液病骨髓细胞构成的相关性。方法:25例确诊的恶性血液病患者通过DCE-MRI及髂嵴穿刺活检进行对照分析,测定骨髓灌注的最大强化率(PER)、最大强化斜率值(Slopemax)、峰值时间(TTP)、平均时间(MT)以及骨髓活检分析细胞构成(Cellularity)。结果:骨髓细胞构成与动态增强的PER呈正相关(r=0.564)、与其Slopemax也呈正相关(r=0.478),统计差异有显著性意义(P<0.05)。骨髓细胞构成与TTP呈负相关(r=-0.305),与MT呈正相关(r=0.186),但统计学上差异无显著性意义(P>0.05)。结论:动态增强MR成像能够监测血液病骨髓细胞构成的变化。     

恶性血液病骨髓动态增强磁共振成像特征的初步研究

目的探讨利用动态增强MR成像技术检测恶性血液病患者骨髓构成的变化，判定其骨髓浸润程度，以减少血液病患者治疗随访过程中穿刺活检的次数。方法25例恶性血液病患者经动态增强MPJ（DCE-MR）及髂嵴穿刺活检，测定骨髓灌注的最大强化率（PER），最大强化斜率值（Slopemax），峰值时间（TTP），平均时间（MT），以及骨髓活检分析细胞构成、肿瘤分数（TF）。结果25例恶性血液病患者骨髓的PER、Slopemax、TTP、MT的中位值分别为0．27、0．21s^-1。、79．08s、84．43s。不同细胞构成（低、正常、高）骨髓的灌注特征性变量的中位数值分别为PER（0．29、0．24、1．15）、Slopemax（0．20s^-1、0．21s^-1、1．28s^-1）、TTP（96．67s、83．49s、25．52s）、MT（77．52s，86．25s，84．34s）。肿瘤浸润组首次灌注值（PER0．32，Slopemax0．28s。）高于肿瘤缓解组，（PER0．20，Slopemax0．20s^-1），而对比剂到达峰值时间（TTP68．66s）低于缓解组（TTP85．85s）。肿瘤浸润组与缓解组骨髓的PER差异有统计学意义（P=0．02），而Slopewmax、TTP、MT差异无统计学意义（P值均＞0．05）。PER（r=0．564，P=0．003）、Slopemax（r=0．478，P=0．016）、MT（r=0．186，P＞0．05）与骨髓细胞构成状态（低、正常、高）呈正相关，而TTP（r=-0．222）与骨髓细胞构成状态呈负相关。PER（r=0．561，P=0．004）、Slopemax（r=0．318，P=0．121）、MT（r=0．207，P＞0．05）与TF呈正相关，而TTP（r=-0．305，P＞O．05）与TF呈负相关。结论动态增强MR成像能够监测恶性血液病骨髓肿瘤细胞浸润和细胞构成的变化。     

乳腺MR灌注时间-信号强度曲线表现及价值研究

目的探讨乳腺MRT2*WI首次通过灌注时间-信号强度曲线(TIC)表现及其在乳腺病变鉴别诊断中的价值。资料与方法对40例乳腺肿瘤患者行乳腺动态增强成像扫描,绘制T2*WI首次通过灌注TIC及T1WI动态增强TIC。采用Fisher’s确切概率法检验,判定良、恶性病灶T1WI动态增强及灌注TIC的差异。结果良、恶性病灶灌注TIC之间差异具有显著性统计学意义(P<0.05=0.000);良、恶性病灶T1WI动态增强TIC之间差异有显著性统计学意义(P<0.05=0.011),但在平台型曲线类型中良恶性病灶有较大重叠。结论乳腺MR灌注TIC在良、恶性病灶具有显著差别,恶性病灶灌注TIC主要表现为信号快速下降后缓慢回升(A型)与快速下降后不回升(B型);良性病灶灌注TIC主要表现为平直型(C型)及缓慢上升后平台型(D型)。灌注TIC与病灶形态学结合可大大提高乳腺疾病诊断的准确性。     

多层CT灌注成像在肺内肿瘤诊断中的应用

目的 研究16层螺旋CT灌注成像在鉴别肺内肿瘤中的价值.方法 对63例肺部单发病变进行前瞻性分析,采用Philips Brilliancel6排螺旋CT对肿块行灌注扫描.用CT灌注软件包进行分析.结果 高及中分化组的灌注值(PV),最高增强值(PE)及血容量(BV)值明显高于低分化及未分化组肺癌,差异均有统计学意义(分别为P<0.01,P<0.01,P<0.05).肺部病变PV、PE、BV值为炎性>恶性>良性,其中PV、PE值各组问差异均有统计学意义,而BV值仅炎性病变与良性病变之间差异有统计学意义(P<0.01);如果以150.05).中央型与周围型肺癌各灌注参数也无统计学意义(P>0.05).结论 螺旋CT灌注成像对鉴别肺内恶性、良性及炎性病变及判别肺癌恶性程度有较大价值.     

兔VX2软组织肿瘤模型的建立与MR灌注成像研究

目的:建立恶性软组织肿瘤动物模型并研究MR灌注成像在软组织肿瘤中的应用价值.材料和方法:8只新西兰大白兔,双侧大腿近段注射VX2肿瘤组织悬液0.1ml,分别于肿瘤组织接种后第14、21天行MR平扫和灌注扫描,扫描图像经AW4.0工作站处理,计算并分析灌注曲线图和灌注参数,包括相对血流量(rBF)、相对血容量(rBV)和平均通过时间(MTT).结果:所有兔大腿VX2肿瘤组织的rBF、rBV值明显高于正常肌肉组织(P<0.01),而MTT值则低于正常肌肉组织(P<0.05).结论:MR灌注成像是一种较准确且安全、简便的半定量评估软组织肿瘤性病变血流灌注状态的功能成像方法.     

Dynamic Contrast Enhanced Magnetic Resonance Imaging of Diffuse Spinal Bone Marrow Infiltration in Patients with Hematological Malignancies

Objective

To investigate the significance of the dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) parameters of diffuse spinal bone marrow infiltration in patients with hematological malignancies.

Materials and Methods

Dynamic gadolinium-enhanced MR imaging of the lumbar spine was performed in 26 patients with histologically proven diffuse bone marrow infiltration, including multiple myeloma (n = 6), acute lymphoblastic leukemia (n = 6), acute myeloid leukemia (n = 5), chronic myeloid leukemia (n = 7), and non-Hodgkin lymphoma (n = 2). Twenty subjects whose spinal MRI was normal, made up the control group. Peak enhancement percentage (E_max), enhancement slope (ES), and time to peak (TTP) were determined from a time-intensity curve (TIC) of lumbar vertebral bone marrow. A comparison between baseline and follow-up MR images and its histological correlation were evaluated in 10 patients. The infiltration grade of hematopoietic marrow with plasma cells was evaluated by a histological assessment of bone marrow.

Results

Differences in E_max, ES, and TTP values between the control group and the patients with diffuse bone marrow infiltration were significant (t = -11.51, -9.81 and 3.91, respectively, p < 0.01). E_max, ES, and TTP values were significantly different between bone marrow infiltration groups Grade 1 and Grade 2 (Z = -2.72, -2.24 and -2.89 respectively, p < 0.05). E_max, ES and TTP values were not significantly different between bone marrow infiltration groups Grade 2 and Grade 3 (Z = -1.57, -1.82 and -1.58 respectively, p > 0.05). A positive correlation was found between E_max, ES values and the histological grade of bone marrow infiltration (r = 0.86 and 0.84 respectively, p < 0.01). A negative correlation was found between the TTP values and bone marrow infiltration histological grade (r = -0.54, p < 0.01). A decrease in the E_max and ES values was observed with increased TTP values after treatment in all of the 10 patients who responded to treatment (t = -7.92, -4.55, and 5.12, respectively, p < 0.01).

Conclusion

DCE-MRI of spine can be a useful tool in detecting diffuse marrow infiltration of hematological malignancies, while its parameters including E_max, ES, and TTP can reflect the malignancies'' histological grade.     

Bone marrow with diffuse tumor infiltration in patients with lymphoproliferative diseases: dynamic gadolinium-enhanced MR imaging

PURPOSE: To evaluate gadolinium enhancement of bone marrow in patients with lymphoproliferative diseases and diffuse bone marrow involvement. MATERIALS AND METHODS: Dynamic contrast material-enhanced magnetic resonance (MR) imaging of the thoracolumbar spine was performed in 42 patients with histologically proved diffuse bone marrow involvement and newly diagnosed myeloma (n = 31), non-Hodgkin lymphoma (n = 8), or Hodgkin disease (n = 3). The maximum percentage of enhancement (Emax), enhancement slope, and enhancement washout were determined from enhancement time curves (ETCs). A three-grade system for scoring bone marrow involvement was based on the percentage of neoplastic cells in bone marrow samples. Quantitative ETC values for the 42 patients were compared with ETC values for healthy subjects and with grades of bone marrow involvement by using mean t test comparisons. Receiver operating characteristic (ROC) analysis was conducted by comparing Emax values between patients with and those without bone marrow involvement. Baseline and follow-up MR imaging findings were compared in nine patients. RESULTS: Significant differences in Emax (P <.001), slope (P <.001), and washout (P =.005) were found between subjects with normal bone marrow and patients with diffuse bone marrow involvement. ROC analysis results showed Emax values to have a diagnostic accuracy of 99%. Emax, slope, and washout values increased with increasing bone marrow involvement grade. The mean Emax increased from 339% to 737%. Contrast enhancement decreased after treatment in all six patients who responded to treatment but not in two of three patients who did not respond to treatment. CONCLUSION: Dynamic contrast-enhanced MR images can demonstrate increased bone marrow enhancement in patients with lymphoproliferative diseases and marrow involvement.     

Normal spinal bone marrow in adults: dynamic gadolinium-enhanced MR imaging

PURPOSE: To determine the patterns of dynamic enhancement of normal spinal bone marrow in adults at gadolinium-enhanced magnetic resonance (MR) imaging and the changes that occur with aging. MATERIALS AND METHODS: Dynamic contrast material-enhanced MR imaging of the thoracolumbar spine was performed in 71 patients. The maximum percentage of enhancement (Emax), enhancement slope, and enhancement washout were determined from bone marrow enhancement time curves (ETCs). The bone marrow signal intensity on T1-weighted spin-echo MR images was qualitatively classified into three grade categories. Quantitative ETC values were correlated with patient age and bone marrow fat content grade. Statistical analysis included mean t test comparison, analysis of variance, and regression analysis of the correlations between age and quantitative MR parameters. RESULTS: Emax, slope, and washout varied widely among the patients. Emax values were obtained within 1 minute after contrast material injection and ranged from 0% to 430%. Emax values were significantly higher in patients younger than 40 years than in those aged 40 years or older (P <.001). These values decreased with increasing age in a logarithmic relationship (r = 0.71). Emax values decreased as fat content increased, but some overlap among the fat content grades was noted. Analysis of variance revealed that Emax was significantly related to age (younger than 40 years vs 40 years or older) (P <.001) and fat content grade (P <.001) but not significantly related to sex. CONCLUSION: Dynamic contrast-enhanced MR imaging patterns of normal spinal bone marrow are dependent mainly on patient age and fat content.     

急性白血病骨髓浸润的动态增强MRI研究及临床意义

目的：采用动态增强MRI(DCE-MRI)分析急性白血病(AL)患者骨髓浸润微循环血流动力学特点及临床意义。方法 47例AL患者行快速小角度激发梯度同波(FLASH)序列T1WI冠状面髋部DCE-MRI,分别在腰椎及双侧髂骨设置ROI,绘制时间-信号强度曲线(ETCs),计算最大强化率（Emax）、强化斜率(slop...     

激素治疗风湿病患者股骨头骨坏死风险评估的MRI研究

目的 观察激素治疗风湿病患者髋部骨及骨髓的MRI表现,分析MRI在股骨头坏死风险评估中的意义.资料与方法 激素治疗的50例风湿病患者行髋关节X线平片及冠状位MRI检查,MRI检查序列包括自旋回波T1WI、脂肪抑制序列(STIR)、动态增强扫描(DCE-MRI).采用股骨骨髓转化系数(MCI)值及DCE-MRI时间-信号强度曲线定量分析激素治疗未发生骨坏死患者股骨骨髓的信号强度及血流灌注;并选取同期年龄相匹配的20例正常志愿者作为正常对照组.结果 50例患者中,5例(6髋)发生股骨头坏死,其中1例为双髋.20例未发生骨坏死的激素治疗患者与正常对照组( 79.51±6.58)相比,股骨MCI明显增高(90.41±5.23),差异有统计学意义(t=4.10,P＜0.01);两组干骺端及股骨头的血流灌注差异有统计学意义(t=4.47,P＜0.05;t=5.12,P＜ 0.05).结论 MRI股骨骨髓转化系数及DCE-MRI是评估股骨头骨坏死风险的有效手段,可为股骨头坏死的临床研究提供影像学依据.     

Bone marrow disorders: characterization with quantitative MR imaging

Thirty patients with various hematologic disorders and 15 healthy control subjects underwent quantitative magnetic resonance (MR) imaging of the lumbar spine with spin-echo techniques. Images of patients with infiltrative bone marrow disorders showed significantly more prolonged T1 times than those of control subjects (P less than .001). It was not possible to distinguish different diffuse infiltrative bone marrow disorders on the basis of T1 values. Aplastic anemia could be distinguished from normality because of significantly shortened T1 (P less than .001). A significant correlation was seen between T1 and bone marrow cellularity (r = .74, P less than .001). T2 was of no value in the characterization of bone marrow disorders. Quantitative MR imaging dose not improve the diagnostic potential of bone marrow imaging in the detection of diffuse marrow infiltrates.     

MRI gadolinium enhancement of bone marrow: age-related changes in normals and in diffuse neoplastic infiltration

 Objective: To quantify gadolinium-related enhancement in the bone marrow of the spine in normals and in patients with homogeneous diffuse malignant bone marrow infiltration. Design and patients: The patients consisted of two groups: group 1 comprised 94 healthy adults (18–86 years) without bone marrow disease and group 2 comprised 30 patients with homogeneous diffuse malignant bone marrow infiltration due to myeloma (n=20) or breast carcinoma (n=10). All patients received intravenous gadopentetate dimeglumine (Gd-DTPA), 0.1 mmol/kg body weight. Pre- and postcontrast signal intensity (SI) on T1-weighted spin-echo (SE) images (TR/TE: 572 ms/15 ms) was measured over a region of interest (ROI) and the percentage SI increase was calculated. The results were confirmed by bone marrow biopsy (n=20) and clinical parameters (n=10). Dynamic contrast-enhanced studies using a spoiled gradient-recalled-echo (GRE) sequence (TR/TE/α: 68 ms/6 ms 75°) were performed in 10 controls with normal bone marrow. Results and conclusion: Contrast material enhancement in healthy persons can vary greatly (range 3–59%, mean 21%, SD 11%). With increasing age there is a significant decrease in contrast enhancement (Pearson’s correlation, P<0.01). The percentage SI increase in patients with intermediate-grade (biopsy 20–50 vol%) and high-grade (biopsy >50 vol%) diffuse malignant bone marrow infiltration was significantly higher than in normals (mean 67%, SD 34%, P<0.001). Low-grade (biopsy <20 vol%) diffuse malignant bone marrow infiltration can not be assessed by non-enhanced T1-weighted SE images or Gd-DTPA application. In conclusion, contrast material enhancement in healthy persons can vary greatly and is dependent on age, while intermediate-grade and high-grade diffuse malignant bone marrow infiltration can be objectively assessed with SI measurements.     

Initial experience with dynamic MR imaging in evaluation of normal bone marrow versus malignant bone marrow infiltrations in humans

The purpose of this study was (a) evaluation of dynamic contrast-enhanced MR imaging of normal bone marrow versus malignant bone marrow infiltrations in patients with proven B-cell-type chronic lymphocytic leukemia (B-CLL) and (b) correlation with the clinical stage according to Binet (stages A, B, C) and response to therapy. Bone marrow imaging of the lumbar spine, pelvis, and proximal femurs was performed at 1.5 T in 45 patients without known malignancy and in 30 patients with B-CLL. The differences between opposed-phase and in-phase dynamic gradient-echo sequences before and up to 10 minutes after intravenous application of .1 mmol/kg body weight of gadolinium-diethylenetriamine penta-acetic acid (Gd-DTPA) were evaluated in normal bone marrow. The contrast-enhancement patterns of normal and malignant bone marrow were compared using the opposed-phase dynamic gradient-echo sequence. Ten of the patients with bone marrow infiltrations (Binet stage C) additionally underwent MR imaging follow-up during therapy. Opposed-phase gradient echo sequences demonstrated a signal decrease of normal bone marrow, and in-phase gradient echo sequences demonstrated a signal increase of normal bone marrow after administration of Gd-DTPA. The dynamic signal intensity time courses differed significantly (P < .05) between Binet stages B and C and controls as well as among the three Binet stages of B-CLL. In the 10 patients followed during therapy, MR imaging sensitively demonstrated response (n = 6), nonresponse (n = 2), or relapse after initial response (n = 2). In out-of-phase imaging, both normal bone marrow and initial bone marrow infiltration in CLL stage Binet A show signal decrease after administration of contrast agent, whereas there is increase in signal intensity in higher-grade bone marrow infiltration in Binet stage B or C disease. The signal loss of normal bone marrow in out-of-phase imaging is a phase effect rather than a T2* effect. The differentiation of initial from higher-grade bone marrow infiltration on out-of-phase images relies solely on a shift in the fat/water ratio.