大范围扩散加权成像鉴别诊断椎体良恶性病变

Large-scale DWI in differential diagnosis of benign and malignant vertebral lesions

目的探讨MR大范围扩散加权成像(DWI)对椎体良、恶性病变的鉴别诊断价值。方法回顾性分析经过病理或临床证实的75例患者的常规MR平扫及大范围DWI资料。良性组42例,其中单纯性骨折24例,血管瘤12例,结核6例;恶性组33例,转移瘤19例,骨髓瘤8例,骨肉瘤3例,白血病2例,骨淋巴瘤1例。分析病变与正常椎体(对照组)大范围DWI信号特点,并测定ADC值,比较良性组、恶性组及对照组之间ADC值的差异。结果良性组、恶性组及对照组的ADC值分别为(1.58±0.54)×10-3mm2/s、(0.98±0.35)×10-3mm2/s、(0.37±0.16)×10-3mm2/s。病变组的ADC值均高于对照组(P均<0.001);良性组ADC值高于恶性组(P<0.001)。结论大范围DWI序列可以全面显示椎体病变范围及程度。定量分析ADC值对鉴别脊椎良、恶性病变具有一定价值,大范围DWI成像可作为椎体病变MR常规检查序列之一。

Objective To investigate the value of large-scale diffusion weighted imaging （DWI） in distinguishing benign and malignant vertebral lesions. Methods Totally 75 patients underwent conventional MR plain scan and large-scale DWI,and the data were retrospectively analyzed. Forty-two patients had benign lesions （benign group）,including simple fractures （n=24）,hemangioma （n=12） and tuberculosis （n=6）. Thirty-three patients had malignant lesions （malignant group）,including metastatic tumors （n=19）,multiple myeloma （n=8）,osteosarcoma （n=3）,lymphoma （n=2） and leukemia （n=1）. Signal characteristics on large-scale DWI were analyzed,while apparent diffusion coefficient （ADC） values of normal （control group） and abnormal vertebral bodies were calculated and compared. Results ADC values of benign group,malignant group and control group were （1.58±0.54）×10-3 mm2/s,（0.98±0.35）×10-3 mm2/s and （0.37±0.16）×10-3 mm2/s,respectively. ADC values of abnormal vertebral bodies were higher （all P0.001）,and in benign group were higher than those in malignant group （P0.001）. Conclusion The large-scale DWI can display the comprehensive scope and extent of vertebral body lesions. Quantitative analysis of ADC has some value in differentiating benign and malignant lesions of the spine. Large-scale DWI can be used as a routine sequence of vertebral body lesions.