脊椎多发性骨髓瘤的MRI表现与鉴别诊断

MRI features and differential diagnosis of multiple myeloma in the vertebra

目的:探讨脊椎多发性骨髓瘤(multiple myeloma,MM)的MRI表现与鉴别诊断,减少误诊。方法:回顾性分析16例经骨髓凃片或局部病灶活检病理证实的脊椎多发性骨髓瘤的MRI表现特点。结果:脊椎MM的MRI表现分为4型:正常型,1例(6.25%),T1WI病灶呈稍高信号,T2WI呈等信号;弥漫型,9例(56.25%),T1WI病灶呈弥漫性低信号,边界较清楚,T2WI呈稍高信号或等信号,边界欠清;局灶型,3例(18.75%),T1WI病灶呈多发结节状、斑片状低信号,边界较清楚,T2WI呈稍高信号或等信号“;椒盐”型,3例(18.75%),表现为弥漫性斑点状高、等、低混杂信号,边界欠清。以上各型在STIR上均呈高信号,病灶显示清楚。椎体受累常为连续性,占68.75%;椎体变形,占31.25%;附件受累,占25%;椎旁软组织肿块,占6.25%。结论:脊椎MM的MRI表现有一定特点,MRI在其诊断及鉴别诊断中有一定的价值。

Objective：To study the MRI features and its value in diagnosis and differential diagnosis of the vertebral multiple myeloma （MM）. Methods： The MRI features of 16 patients with vertebral MM proved by histology were retrospectively analyzed. Results： The vertebral MM was classified into the following four types ：Normal type accounted for 6.25%, in which the lesions were mild hyper-intensity on T1WI and iso-intensity on T2WI. Diffuse type accounted for 56.25% , in which the lesions were diffuse hypo-intensity with clear border on T1WI and hyper-intensity with indistinct border or iso-intensity on T2WI. Localized type accounted for 18.75%, in which the lesions were multiple nodular or patchy hypo-intensity on T1WI and mild hyper-intensity or iso-intensity on T2WI. ＂Salt with pepper＂ type accounted for 18.75%, in which the lesions were diffuse spot-like mixed hyper-, iso-and hypo-intensity. The all lesions were hyper-inten- sity on STIR images. The involved vertebrae were continuous, which accounted for 68.75%. The vertebral bodies were metamorphosed in 5 cases （31.25%） . The appendixes were involved in 4 cases （25%） . The paravertebral soft tissue mass was found in only 1 case （6.25%） . Conclusion： The vertebral MM has some features on MRI. MRI is valuable in diagnosis and differential diagnosis of the vertebral MM.