肿瘤放疗后照射野内骨髓的MRI表现

目的 探讨肿瘤放疗后骨髓磁共振成像(MRI)的特征和临床应用价值.方法 对15例肿瘤放疗前后照射野内的骨髓行MRI检查.结果 与放疗前相比,放疗后照射野内局部骨髓的T1WI、T2WI信号有明显提高,信号均匀,分界清晰.T1WI增强扫描,骨髓未见明显强化.结论 肿瘤放疗引起的照射野内骨髓MRI信号改变具有特征性,能够指导肿瘤的临床治疗.     

早期乳腺癌动态增强MRI诊断

 目的　提高对早期乳腺癌动态增强MRI征象的认识。方法　分析 9例早期乳腺癌动态增强MRI表现特征 ,总结早期乳腺癌的特征性MRI表现。结果　早期乳腺癌动态增强MRI表现 :①病灶形态多数表现为片状、团块状强化区域 ,边界不清 ,形态不规则 ,少数表现为分叶状小结节或沿导管走行的条带状强化 ;②MIP :多数病灶周边可见细小密集血管影 ;③SI Time曲线大部分为II型和III型 ,但少数为I型。结论　早期乳腺癌MRI表现具有一定特征性 ,但有些与乳腺良性病变易混淆 ,对可疑病变的诊断必须结合X线钼靶摄影才能提高诊断准确性。     

小儿急性白血病骨髓MRI表现的观察

急性白血病是儿科最常见的恶性肿瘤之一 ,其诊断及疗效观察主要依靠骨髓穿刺或活检。磁共振成像 (ｍａｇｎｅｔｉｃｒｅｓｏ ｎａｎｃｅｉｍａｇｉｎｇ ,ＭＲＩ)也可反映骨髓组织结构的变化。国内尚未见关于小儿急性白血病骨髓的ＭＲＩ变化的研究报道 ,我们从 1998年 3月至 2 0 0 0年 3月 ,对 16例小儿急性白血病患儿进行了ＭＲＩ检查和观察 ,现报告以下。1　临床资料1.1　对象病例组 :16例急性白血病患儿经骨髓细胞学检查确诊 ,其中男性 8例 ,女性 8例 ,年龄 3～ 13岁。其中急性淋巴细胞白血病 (ａｃｕｔｅｌｙｍｐｈｏｃｙｔｉｃｌｅｕｋ…     

骨髓切片和涂片观察在恶性血液病诊断中的意义

 目的 应用骨髓切片和涂片相结合,观察骨髓组织和细胞形态学的变化,对120例初发的血液病患者的骨髓进行切片和涂片的结果分析,以期得到形态学诊断的新途径。方法 收集恶性血液病病例120份。一步法抽吸骨髓,常规方法涂片染色,塑料包埋法制作组织切片;恶性血液病的诊断参照2001年WHO分型标准。结果 骨髓活检与骨髓涂片相结合,在诊断骨髓纤维化、低增生MDS、骨髓转移癌和骨髓坏死,骨髓组织切片的诊断符合率高于穿刺涂片。对于淋巴瘤骨髓侵犯的病例,骨髓组织切片中更容易找到有特征的淋巴瘤细胞;对慢性粒细胞白血病（CML）病例,组织切片较穿刺涂片提前找到诊断急变的证据。结论 骨髓形态学检验,将组织切片与穿刺涂片相结合,互为补充,可以有效地提高恶性血液病的诊断水平。     

白血病骨髓磁共振成像的定量测定

背景与目的:国内外对白血病骨髓磁共振成像(MRI)及MRI与临床实验室指标的相关性进行了大量的研究,但将淋巴细胞性白血病(lymphoidleukemia,LL)与髓细胞白血病(myeloidleukemia,ML)分开研究的不多。本研究分别测量LL与ML脊柱骨髓MRI信号强度比(signalintensityratio,SIR),探讨MRI定量测量在白血病组织学定性诊断(LL与ML)及肿瘤负荷评价中的作用。方法:对初诊的20例LL,10例ML进行脊柱骨髓MRI检查,全部白血病的诊断均经骨髓细胞学检查证实。脊柱骨髓MRI检查使用0.5T超导型磁共振成像系统,进行自旋回波(spinecho,SE)序列T1加权像(T1WI)及快速自旋回波(turbospinecho,TSE)序列T2加权像(T2WI),在T1WI上测量白血病骨髓SIR,同时进行外周血常规检查及髂骨骨髓细胞学检查。结果:20例LL和10例ML脊柱骨髓SIR分别为0.72±0.11、0.73±0.11,LL与ML之间SIR无统计学差异(P=0.836)。LL中脊柱骨髓SIR与骨髓内淋巴系幼稚细胞比均呈负相关(r=-0.836,P=0.000)。ML脊柱骨髓SIR与骨髓内粒系幼稚细胞比呈负相关(r=-0.673,P=0.033)。结论:SIR不能区分LL、ML,其组织学定性诊断价值有限,但SIR可评价白血病的肿瘤负荷。     

恶性血液病继发骨髓纤维化71例病理及临床研究

 【摘要】 目的 探讨继发性骨髓纤维化(secondary myelofibrosis,SMF)患者的临床及骨髓病理学特征。方法 对71例继发性骨髓纤维化患者的临床表现、外周血涂片、骨髓涂片及骨髓活检情况进行了回顾性研究,同时对不同疾病骨髓纤维化程度与巨核细胞数目作了相关分析。结果 分析71例SMF患者,其原发病情况为慢性粒细胞白血病(CML)20例(28.2%),急性淋巴细胞白血病（ALL）6例（8.5%）,急性髓系细胞白血病(AML)、骨髓增生异常综合症（MDS）、淋巴瘤各10例（14.1%）,多发性骨髓瘤（MM）、淋巴增殖性疾病（LPD）各4例（5.6%）,骨髓增殖性肿瘤（MPN）3例,慢性淋巴细胞白血病（CLL）2例,骨髓转移癌、传染性单核细胞增多症各1例。骨髓纤维化程度与巨核细胞数具有明显相关性（P＜0.05）。结论 继发性骨髓纤维化患者骨髓切片巨核细胞增生明显,且与纤维化程度有相关性。这可能与巨核细胞克隆性增殖释放的多种细胞因子积极参与骨纤的发生发展密切相关。     

Detection of malignant bone marrow involvement with dynamic contrast-enhanced magnetic resonance imaging.

BACKGROUND: The purpose of this study was to evaluate the role of dynamic contrast-enhanced magnetic resonance imaging (dMRI) in detecting bone marrow involvement in cancer patients. PATIENTS AND METHODS: We studied 50 consecutive patients with histologically confirmed malignant dissemination to the bone marrow, using dMRI of the lumbosacral spine. Time-signal intensity curves were generated from regions of interest (ROIs) obtained from areas of obvious bone marrow disease (group B). In 16 patients from group B with focal disease, ROIs were also placed on areas with apparently normal bone marrow on static magnetic resonance images (group C). Twenty-two patients with no history of malignancy were used as a control group (group A). Wash-in (WIN) and wash-out (WOUT) rates, time to peak (TTPK), time to maximum slope (TMSP) values and WIN/TMSP ratios were calculated for each patient. Mean values for the three groups were compared statistically. Six patients from group B had follow-up dMRI after chemotherapy: four patients achieved a clinical partial response and two had resistant disease. RESULTS: A significant difference was found between groups A and B for all values. Between groups A and C, in spite of the similar static MRI appearance, all values were significantly different. Between groups B and C, a significant difference was found for WIN, WOUT rates and WIN/TMSP ratio. Follow-up dMRI data analysis correlated well with clinical staging. CONCLUSIONS: dMRI can distinguish normal from malignant bone marrow. It may identify malignant bone marrow infiltration in patients with negative static MRI and serve as both a diagnostic and prognostic tool for patients with bone marrow malignancies.     

Prognostic factors in patients with bone marrow hemophagocytosis and its association with hematologic malignancies

Hemophagocytic lymphohistiocytosis (HLH) is a heterogeneous group of hyperinflammatory statuses that are difficult to diagnose and can be life-threatening. Bone marrow (BM) hemophagocytosis is one of the diagnostic criteria according to HLH 2004 diagnostic criteria and HS score. Limited studies have focused on the prognostic factors of BM hemophagocytosis and its association with hematologic malignancies. We aimed to analyze the clinical significance of BM hemophagocytosis. Patients with BM hemophagocytosis, either by cytology or pathology, were enrolled at Taipei Veterans General Hospital from January 2002 to July 2021. Relevant clinical and laboratory data were extracted from medical records. Of 119 patients with BM hemophagocytosis, 57 were diagnosed with hematologic malignancies. The median age of the patients was 58, ranging from 21 to 90. Splenomegaly (adjusted odds ratio [aOR] 2.96; 95% confidence interval [CI] 1.13–7.79) was a risk factor for hematologic malignancies, while autoimmune disease (aOR 0.07; 95% CI 0.01–0.39) and increased D-dimer (aOR 0.25; 95% CI 0.07–0.92) were protective factors. Risk factors for mortality in patients with BM hemophagocytosis were hematologic malignancies (adjusted hazard ratio [aHR] 2.34; 95% CI 1.24–4.44), Eastern Cooperative Oncology Group score ≥3 (aHR 2.42; 95% CI 1.20–4.89) and thrombocytopenia (aHR 3.09; 95% CI 1.04–9.16). In conclusion, among patients with BM hemophagocytosis, splenomegaly was a predictor of hematologic malignancies. Patients with hematologic malignancies, poor performance status, or thrombocytopenia had a higher mortality risk. Further validation studies are warranted.     

骨髓活检对诊断非霍奇金淋巴瘤骨髓浸润及分期意义的探讨

目的:探讨骨髓活检切片分析在非霍奇金淋巴瘤骨髓浸润(NHLBMI)诊断及临床分期方面的价值。方法:对128例非霍奇金淋巴瘤患者行骨髓活检术,分析活检切片。结果:骨髓活检切片中非霍奇金淋巴瘤骨髓浸润的阳性率为35.9%(46例)。经骨髓活检后,16例Ⅰ～Ⅲ期提升为Ⅳ期,骨髓活检前、后Ⅳ期所占比例有明显差异(P<0.01)。结论:骨髓活检切片分析对非霍奇金淋巴瘤骨髓浸润的诊断及临床分期具有重要意义。     

淋巴瘤侵犯骨髓的骨髓活检病理学诊断研究进展

淋巴瘤侵犯骨髓(lymphomabonemarrowinvolvement,LBMI)主要靠骨髓活检确诊。霍奇金淋巴瘤(Hodgkin蒺slymphoma,HL)、非霍奇金淋巴瘤(non-Hodgkin蒺slymphoma,NHL)侵犯骨髓各有其不同病理特点。骨髓中瘤细胞的形态特点、分布方式及免疫表型多数与髓外部位一致,少数又可存在差别。本文比较了各型HL、B-NHL、T-NHL的骨髓侵犯病理学特点,并从形态学、免疫组化及淋巴瘤基因重排检测三方面对LBMI的骨髓活检诊断研究进展进行了综述。     

Tc-99m labelled anti CD 66 antigranulocyte antibody imaging for assessment of bone marrow reserve

Patients with metastatic disease to the bone marrow are at risk of significant hematologic toxicity, if they undergo myelotoxic chemotherapy. Tc-99m labelled Anti CD 66 monoclonal antibody imaging is a useful, noninvasive approach to the assessment of bone marrow reserve under such circumstances.     

骨髓涂片、骨髓活组织检查及流式细胞术在淋巴瘤骨髓侵犯诊断中的比较

目的 比较骨髓涂片、骨髓活组织检查和流式细胞术三种方法对淋巴瘤患者骨髓受累的检测情况,为临床检测骨髓受累提供选择.方法 收集68例恶性淋巴瘤初治患者,观察骨髓涂片、骨髓活组织检查和流式细胞术三种方法检测淋巴瘤患者骨髓受累的阳性率.结果 68例恶性淋巴瘤患者检测骨髓受累时,骨髓涂片、骨髓活组织检查和流式细胞术的阳性率分别为16.2％（11/68）、33.8％（23／68）和10.3 ％（7/68）,骨髓活组织检查阳性率高于涂片和流式细胞术检查,三种方法阳性率差异有统计学意义（P＜0.05）.对三种检测方法进行相关性分析,骨髓涂片与骨髓活组织检查存在相关性（P=0.002）,与流式细胞术没有相关性（P=0.270）.结论 骨髓涂片细胞形态学检查是检测淋巴瘤患者是否有骨髓受累的基础方法,骨髓活组织检查阳性率较高,有明显的优势,但需与骨髓涂片互为补充.     

Oral mucormycosis in patients with haematologic malignancies in a bone marrow transplant unit

Mucormycosis is an aggressive and life‐threatening opportunistic fungal infection, which predominantly affects immunocompromised patients. It typically manifests in rhinocerebral, pulmonary or disseminated forms in patients with immunosuppressive conditions. Mucormycosis limited to the oral cavity is rare, and to the best of our knowledge only seven cases have previously been reported in English literature. We present five consecutive cases of oral mucormycosis in patients with leukaemia, and provide a literature review.     

3.0T MR动态增强技术对胰腺肿瘤非病变区域的半定量分析研究

目的对正常胰腺、胰腺癌及胰腺良性肿瘤患者的3.0T MR快速三维动态增强扫描序列进行半定量分析,为临床提供胰腺肿瘤非病变区域的灌注特点及判断潜在病变的半定量指标。方法对40例非胰腺疾病患者(对照组)、43例经病理证实的胰腺癌患者(胰腺癌组)、26例胰腺良性肿瘤患者(胰腺良性肿瘤组)行全胰腺T1权重LA-VA 9期动态增强扫描,将所得数据传至ADW 4.2工作站处理,分别测量对照组胰腺的头、体、尾的30s强化率(SER30)、90s强化率(SER90)、达峰时间(TTP)、正增强积分(PEI)、最大强化斜率(MSI),胰腺癌组及胰腺良性肿瘤组的非病变区域的SER30、SER90、TTP,对所得数据进行统计学分析。结果对照组胰腺头、体、尾的SER30、SER90、PEI、TTP及MSI差异无统计学意义(P0.05)。胰腺良性肿瘤组非病变区域与对照组任意区域的各项参数差异均无统计学意义(P0.05);胰腺癌组非病变区与对照组任意区域及胰腺良性肿瘤组非病变区的SER90及TTP均有显著性差异(P0.05)。结论正常胰腺的不同部位间无灌注差异;胰腺癌的非病变区域存在潜在病变浸润。     

Allogeneic bone marrow transplantation in 24 patients with multiple myeloma reported to the EBMT registry

Twenty-four patients with multiple myeloma received an allogeneic bone-marrow graft from HLA-compatible sibling donors (n = 23), or a twin donor (n = 1). Eighteen patients are alive, 1-36 months post bone-marrow transplantation (median 14 months). Ten of these patients had no signs of multiple myeloma as judged by immunoglobulins in serum, light chains in urine, or the percentage of plasma-cells in bone-marrow aspirate. Bone lesions on X-ray were mainly unchanged. Six patients died from transplant-related complications 3 weeks to 5 months post transplantation. One of these patients had severe acute graft-versus-host disease (aGVHD). In other patients aGVHD was a minor problem. Allogeneic bone-marrow transplantation appears to be a promising method for treatment of a selected group of patients with multiple myeloma.