成人急性髓细胞白血病骨髓MRI与染色体变异对照

Comparison of bone marrow MR imaging and chromosome aberrations in adult patients with acute myeloid leukemia

目的观察成人急性髓细胞白血病(AML)患者骨髓的MRI表现,并与细胞遗传学相对照。方法对临床确诊的46例成人AML患者采用SE序列及快速反转恢复(STIR)序列冠状面扫描行骨盆及股骨中上段骨髓MRI,患者骨髓标本行细胞遗传学检查。结果AML患者骨髓MRI表现按浸润范围分为5级,其中Ⅰ～Ⅲ级36例,缓解29(29/36)例;Ⅳ～Ⅴ级10例,缓解3例(P<0.05)。依据MRC制定的染色体预后评价标准将AML分为好、中、差三组,各组缓解人数分别为预后好组10例,均获缓解;预后较好组28例,缓解20例;预后差组8例,缓解2例。MRC不同预后的染色体核型变异在MRI骨髓分级中的分布差异显著(P<0.05)。结论MRI能反映AML骨髓浸润特征,MRI对AML病情的评估、预后评价有重要的临床应用价值。

Objective To investigate the correlation between MR imaging of bone marrow and chromosome aberrations in adult patients with acute myeloid leukemia (AML). Methods MR scanning was performed in 46 adult patients with AML and 10 age-matched volunteers. MR imaging of bone marrow in pelvis and femur was obtained by the short time inversion recovery and T1-weighted spin echo technique. The chromosome of all patients was examined. All 46 cases were divided into two groups: one was distributed from grade 1 to grade 3, and the other was from grade 4 to grade 5. Results MR imaging showed that bone marrow of all patients were infiltrated by leukemia cells and MRI features of all patients were classified into five patterns according to scope of focus in femur. The difference of the two groups was statistically significant (P<0.05) in the rate of remission. All cases were divided into three groups according to the MRC criteria on chromosome aberrations: Favorable inv (16)/t (16;16)/del (16q), t (15;17), t (8;21) with/without secondary abn; Intermediate normal, 11q23 abn, +8, del (9q), del (7q), +21, +22, all others. Unfavorable del (5q)/-5,-7, abn (3q), complex karyotypes (≥5 unrelated abn) t (9;22) and t (6;9). The patients in favorable and intermediate groups had higher rate of complete remission than in unfavorable groups (P<0.05). The difference of chromosome aberration was distributed in different patterns of MRI. Conclusion MRI can present a more global view of the bone marrow than biopsy material and therefore may provide imaging basis in predicting prognosis for patients with AML.