骨髓异常的磁共振成像及其临床应用研究

目的：探讨磁共振成像（magnetic reconance imaging,MRI) 在评价骨髓病变中的作用。方法：定性定量分析78例正常人群、44例骨髓病变患者（15例白血病、13例非霍奇金氏淋巴瘤、16例增生性贫血）的脊柱MRI汲骨髓穿刺、外周血检查资料，并将MRI定量资料与临床实验室检查资料进行相关性分析。全部病例均经骨髓穿刺或活检证实。结果：①白血病及淋巴瘤T1加权像（T1-weigted imaging,T1WI)低信号多于增生性贫血及正常人群（P＜0．05），T2加权像（T2-weigted imaging,T2WI)高信号多于增生性贫血及正常人群（P＜0．05）；正常人群、白血病、淋巴瘤强化无差异（P＞0．05）；白血病弥漫性浸润多于淋巴瘤（P＝0．000）。②T1WI白血病及淋巴瘤骨髓肌肉信号强度比（signal intensity ratio on T1WI,SIR1)低于增生性贫血及正常人群（P＜0．05）。③增生性贫血SIR1与粒细胞和红细胞之比呈正相关（P＝0．006），与骨髓中红细胞比例负相关（P＝0．008）；白血病SIR1与骨髓幼稚细胞比例负相关（P＝0．048）。结论：MRI可显示脊柱红骨髓的分布；MRI定性分析可区分良、恶性骨髓病变；定量分析SIR1诊断价值有限；SIR1可评价增生性贫血的贫血程度，粗略预测白血病的瘤负荷。

Clinical Applications of Magnetic Resonance Imaging for Patients with Bone Marrow Diseases

Objective：This study was designed to evaluate the clinical application of magnetic resonance imaging (MRI) in the patients with bone marrow diseases. Methods： A total of 78 normal persons and 44 patients with bone marrow diseases including 15 with leukemia, 13 with non Hodgikin s lymphoma, 16 with hyperplastic anemia were examined with spinal MRI and bone marrow aspirations and peripheral blood tests. MR imagings and clinical data were qualitatively and quantitatively analyzed, meanwhile, quantitative MRI information was correlated with clinical experimental parameters. All the diagnosis had been pathologically proven by bone marrow aspiration or/and biopsy. Results： ① On T1 weighted imaging(T1WI), leukemia group and lymphoma group showed more hypo intensity signals than hyperplastic anemia group and normal group (P< 0.05). On T2 weighed imaging (T2WI), more hyper intensity showed in the two former than in hyperplastic anemia and normal group (P< 0.05). After injection of contrast material, normal group, leukemia group, and lymphoma group had not manifested different degree of enhancement (P >0.05). Diffuse signal changes occurred more often in leukemia group than in lymphoma group (P=0.000). ② On T1 weighted imaging, the signal intensity ratio of marrow to muscle(SIR1) in leukemia group and lymphoma group were lower than that in normal group and hyperplastic anemia group (P< 0.05). ③ SIR1 of hyperplastic anemia was correlated positively with myelocyte erythroblast ratio(P=0.006), negatively with the percentage of erythrocyte in bone marrow (P=0.008), SIR1 of leukemia was correlated negatively with the percentage of premature cell in bone marrow (P=0.048). Conclusions： MRI can directly reveal the distribution of red marrow in spine. Malignant and benign marrow processes can be differentiated on MRI with qualitative analysis; The usefulness of quantitative analysis of SIR1 is limited, but it could be used to roughly evaluate the severity of hyperplastic anemia and tumor burden of leukemia.