磁共振成像诊断急性白血病骨髓浸润的临床应用

目的 运用磁共振成像(MRI)定量检测骨髓增强前后强化率，研究急性白血病患骨髓浸润性病变．探讨MR成像在诊断急性白血病骨髓浸润中的应用价值。方法：40例正常志愿和41例骨髓穿刺证实的急性白血病初发患作为研究对象。正常志愿行常规腰椎及骨盆MRI检查，急性白血病初发患于确诊后初次治疗前行常规腰椎及骨盆MRI检查。MR扫描序列包括T1WI、脂肪抑制短时反转回复序列(STIR)、增强T1WI，MR增强采用马根维显作为对比剂。增强扫描参数与平扫参数保持一致。分析41例急性白血病患治疗前的骨髓MRI表现、定量测定骨髓强化后的MR信号增强率，与骨髓穿刺、核素显像结果及正常组MR强化率等作比较。结果：41例经骨髓穿刺证实的急性白血病患中，初次治疗前MR成像发现有骨髓浸润的41例，均为弥漫性浸润，增强扫描后发现骨髓异常强化，平均强化率为119．95％，最高强化率为368．06％，骨髓穿刺结果均为阳性，核素显像除1例阳性外，其余皆为阴性。MR增强扫描定量分析提示骨髓浸润性病变存在异常强化，强化率明显高于正常组骨髓。结论：MRI作为无创性的成像技术，能一次对大量骨髓组织进行检查，可清楚显示病变的细微结构．反映病变的成分改变情况，骨髓的强化程度还可在一定程度上反映骨髓异常造血的存在。根据MR表现与骨髓穿刺结果，对诊断急性白血病骨髓浸润，制定临床化疗方案及疗效评价有很大的帮助。

Clinical value of MRI in detecting the bone marrow infiltration of acute leukemia

Objective To evaluate the clinical value of MRI quantitative assessment with gadolinium enhancement in detecting the bone marrow infiltration of acute leukemia. Methods From May 2003 to Dec 2003, 41 patients with acute leukemia, including 22 males and 19 females ,were diagnosed clinically in our hospital. The patients underwent both scintigraphy and MR examinations of bone marrow. The ages in the patients group ranged from 30 to 70 years old (mean 47.5 years old) and the course of the disease ranged from 3 months to 3 years (mean 1.2 years). Forty healthy controls including 23 males and 17 females also underwent MR examination of bone marrow. The MR examination was employed with GE Signa 1.5T MR equipment. Routine MR sequences applied were T1WI?STIR(short time inversion recovery) and T1WI with gadolinium enhancement. MR manifestations and bone biopsy results in the patients and in the controls were reviewed retrospectively. Results MRI findings indicated that the 41 patients had bone marrow infiltration with the same results from bone marrow biopsy, but bone scintigraphy showed positive result only in 1 patient. The main pattern of bone marrow infiltration found in MR examination in the patients was uniform. All bone marrow lesions detected by MRI had gadolinium enhancement. The highest bone marrow enhancement percentage was over 300%. Statistical analysis indicated that the enhancement rate in the normal bone marrow was significantly different from that in the bone marrow infiltration lesions. Conclusions MRI presents a more global view of the bone marrow than bone biopsy samples do. It has higher spatial resolution in demonstrating the bone marrow lesions and may provide a better understanding of the disease progression.