动态增强磁共振成像对恶性血液病骨髓肿瘤浸润监测的初步研究

Signs of tumor infiltration of bone marrow in patients with hematological malignancies on dynamic contrast-enhanced MR imaging:preliminary results

目的本研究旨在利用动态增强MR成像技术(DCE-MR)检测血液病患者骨髓强化特征变化,研究其与骨髓肿瘤细胞浸润状态的相关性。方法25例血液病经DCE-MR成像及髂嵴穿刺活检,测定骨髓灌注的最大强化率(PER),最大强化斜率值(Slopemax),峰值时间(TTP),平均时间(MT),以及骨髓活检分析肿瘤分数(TF)。结果肿瘤浸润组较缓解期组PER高(临床缓解期为0.252±0.156,肿瘤组为0.592±0.433),统计学上有显著性差异(P<0.05)。肿瘤浸润组较缓解期组的Slopemax高肿瘤组:(0.561±0.634)/s;缓解期组:(0.204±0.105)/s、TTP缩短肿瘤组:(68.12±42.18)s;缓解期组:(81.52±38.49)s,但统计学上无显著性差异(P>0.05),MT值两组差异不明显(P>0.05)。结论动态增强MR成像能够监测血液病骨髓肿瘤细胞浸润状态,为恶性血液病治疗随访提供了一种新的无创性监测手段。

Objective Using dynamic contrast-enhanced MR imaging （DCE-MRI） to evaluate the bone marrow status, and to determine whether several calculated parameters derived from the DCE-MRI correlate with the marrows histological characteristics, especially with the tumor fraction. Methods DCE-MRI results were obtained from 25 patients with proven or known hematological malignancies about to undergo bone marrow biopsy of the posterior iliac crest. MRI examination of the area to be biopsied was done approximately one hour prior to the bone marrow biopsy. Time-signal intensity curves （TIC） were generated from the region of the lilac crest corresponding to the planned biopsy site. Enhancement parameters were calculated, including peak enhancement ratio （PER）, maximum enhancement slope （Slopemax）, time to peak （TTP） and mean time （MT）. The biopsy specimen was reported synoptically, with relevant reported parametersincluding cellularity and tumor fraction （TF）. Results PER values were significantly higher for the bone marrow tumor infiltration group than for the normal bone marrow group （P〈0.05）. A significant positive correlation was found between PER and TF, Slopemax and TF. A negative correlation was found between TTP and TF. But mean TTP and MT values for the bone marrow tumor infil- tration group and the normal bone marrow group did not differ significantly. Conclusion Our preliminary findings suggest that the presence of diffuse bone marrow infiltration in patients with hematological malignancies can be verified using DCE- MRI.