【作者】 崔久法；

【导师】 徐文坚；

【作者基本信息】 青岛大学 ， 医学影像学与核医学， 2008， 硕士

【摘要】 目的探讨腰椎多发性骨髓瘤的MRI表现,DWI序列在诊断腰椎多发性骨髓瘤中的价值并对FSE T2WI脂肪抑制前后SNR差值及ADC值定量分析。方法搜集经临床骨髓穿刺确诊腰椎多发性骨髓瘤患者20例(病变组)及正常志愿者20例(对照组),分别于临床治疗前行腰椎矢状位FSE T1WI、FSE T2WI、脂肪抑制FSE T2WI(FS-FSE T2WI)及单次激发自旋回波—回波平面DWI(SS-SE-EPI-DWI)检查,分析不同类型腰椎多发性骨髓瘤的MRI表现,并对FSE T2WI脂肪抑制前后正常与病变椎体的SNR(signal noise ratio)差值和ADC(ApparaentDiffusion Coefficient)值进行比较。利用原始图像后处理重建病变椎体的ADC图,并观察其表现。结果(1)常规MRI表现:正常型3例,占15%,MRI T1WI病灶表现为稍高信号,T2WI呈等信号;弥漫型、局灶型分别为5例、9例,占25%、45%,MRI表现为T1WI病灶呈弥漫性或结节状低信号,T2WI呈高信号或等信号;“椒盐型”3例,占15%,MRI表现为弥漫性黑白相间的点状或小颗粒状高、低混杂信号。以上各型FS-FSE T2WI上均呈高信号。在DWI上正常型呈均匀一致等信号;弥漫型整个椎体呈现高信号;局灶型呈现局部团块状高信号;椒盐型呈现散在结节状高信号。(2)SNR差值:在T2WI序列上,病变组病变椎体脂肪抑制前后SNR差值(2.99±3.91)明显低于正常对照组椎体(9.19±2.83),其间差别具有显著统计学意义(P＜0.01)。(3)ADC值:b=400s/mm~2及b=600s/mm~2时,病变组病变椎体(0.972±0.414、0.885±0.367)均比正常对照组椎体(0.503±0.272、0.494±0.273)ADC值高,其间差别具有显著统计学意义(P＜0.01)。95%可信区间显示两者之间有很大一部分重叠区域(0.12～1.73,0.01～0.83)。病变椎体及正常椎体在不同b值时ADC值间的差别没有统计学意义(P＞0.05)。结论腰椎MM的SS-SE-EPI-DWI成像可以用于弥散效应的定量检测,由DWI像上测得的ADC值是鉴别MM椎体与正常椎体的可靠指标。更多还原

【Abstract】 Objective To discuss the MRI features of the lumbar multiple myeloma（MM）.To study diffusion-weighted imaging（DWI） on patients with lumbar multiple myeloma and evaluate the difference of signal noise ratio（SNR） and apparent diffusion coefficients （ADCs） in diagnosis.Methods 20 patients with lumber MM（confinnde by clinic and pathology） and 20 controls were performed with sagittal SE T1WI,FSE T2WI,Fat saturation FSE T2WI （FS-FSE T2WI） and single-shot spin-echo echoplanar DWI（SS-SE-EPI-DWI）, respectively.Analysis MRI features of different Types of MM.The difference of SNR on FSE T2WI and FS-FSE T2WI and ADCs of lumbar MM and normal vertebrae on DWI with different b values were analyzed.ADC maps were reconstructed and observed in patients with lumbar MM.Results（1）Routine MRI appearance:The vertebral MM was classified into the following four types:Normal type accounted for 15%,in which the lesions were mild hyper-intensity on T1WI,iso-intensity on T2W1 and hypo-intensity on DWI.Diffuse type accounted for 25%,in which the lesions were diffuse hypo-intensity with clear border on T1WI,hyper-intensity with indistinct border or iso-intensity on T2WI and hyper-intensity on DWI.Localized type accounted for 45%,in which the lesions were multiple nodular or patchy hypo-intensity on T1WI,mild hyper-intensity or iso-intensity on T2WI and hyper-intensity on DWI."Salt with pepper"type accounted for 15%,in which the lesions were diffuse spot-like mixed hyper-,iso-and hypo-intensity.All lesions were hyper -intensity on FS-FSE T2W1.（2） SNR_T2WI-SNR_FS-T2WI:On T2WI,SNR difference of bone marrow on FSE T2WI and FS-FSE T2WI of MM group（2.99±3.91） was significantly lower than the control group（9.19±2.83）.（3）ADC:the ADCs of leisions and normal vertebra in control group were:b=400s/mm²（0.972±0.414、0.885±0.367）,b=600s/mm² （0.503±0.272、0.494±0.273）.The former are significantly higher than the the latter（P＜0.01）.The absolute values and the 95%CIs of these two entities showed substantial overlap.There were no difference in the ADCs of the same ROIs on DWI between different b values.Conclusion SS-SE-EPI-DWI（single-shot spin-echo echoplanar imaging diffusion -weighted imaging） of the spine is feasible for quantitative analysis of diffusion effects, and the ADCs calculated from diffusion-weighted MR images is a reliable parameter with which to distinguish multiple myeloma from normal vertebrae.更多还原