淋巴瘤骨髓浸润的磁共振成像定性和定量诊断价值

Value of MRI in qualitative and quantitative diagnosis of bone marrow infiltration in lymphoma

目的探讨磁共振成像（MRI）对淋巴瘤患者骨髓浸润的定性及定量诊断价值。方法回顾性分析28例确诊淋巴瘤骨髓浸润的患者，MRI定性分析脊柱骨髓浸润的影像特征，定量测量病变骨髓与脑脊液在T1加权图像上的信号强度比（SIR1）。以31例正常脊柱骨髓为对照组。结果定性诊断：27例患者脊柱骨髓MRI见异常信号，1例假阴性，MRI诊断的敏感度为96．4％；淋巴瘤骨髓浸润的脊柱MRI表现主要有4种类型，分别为局灶型21．4％（6／28），多灶型53．6％（15／28），斑驳型14．3％（4／28），弥漫型7．1％（2／28）。定量诊断：淋巴瘤组骨髓的SIR1（1．251±0．253）明显低于对照组（2．625±0．434），两组差异有统计学意义（t=15．022，P〈0．001）；轻、中、重度骨髓浸润SIR1值（分别为1．390±0．172、0．982±0．790、0．908±0．122）与对照组比较，差异均有统计学意义（均P=0．000），骨髓浸润轻度与中度组间、轻度与重度组间SIR1值差异有统计学意义（LSD法，P=0．012，P=0．025），中度与重度组间的SIR1值的差异无统计学意义（LSD法，p=0．757）；淋巴瘤骨髓浸润的骨髓SIR1值与骨髓中浸润的瘤细胞百分比呈负相关（r=-0．765，P〈0．001）。结论MRI无创、直观，能够展示骨髓全貌，对淋巴瘤骨髓浸润诊断敏感度高，定量分析能一定程度区分骨髓浸润程度，并反映骨髓中瘤细胞负荷量。

Objective To evaluate the value of MRI in qualitative and quantitative diagnosis of bone marrow involvement in patients with lymphoma. Methods 28 diagnosed lymphoma with bone marrow infiltration and 31 healthy spines as controls were included. MRI performance and the signal intensity ratio on T1WI （SIR1） of the spine bone marrow and cerebrospinal fluid were analyzed and statistical analyses were performed. Results Qualitative diagnosis among these patients, was shown than MRI results indicated that 27 cases had abnormal signal. The sensitivity of MRI was 96.4 %. There were four main patterns of marrow infiltration in MRI, containing nodular pattern 21.4 % （6/28）, scattered pattern 53.6 % （15/28）, mottled pattern 14.3 % （4/28） and uniform pattern 7.1% （2/28） respectively. By quantitative diagnosis the SIR1 of study group （1.251±0.253） was apparently lower than that in the control group （2.625±0.434） with statistical significance （t =15.022, P 〈 0.001）. The results of multiple comparisons showed that the SIR1 of mild degree （1.390±0.172）, moderate degree （0.982±0.790） and severe degree （0.908±0.122） patients with lwhoma compared with the normal controls had significant differences （all P = 0.000）, and difference between and moderate degree had statistical significance （LSD, P =0.012）, so did the difference between mild and oevere degree （LSD, P =0.025）. However, no significant difference could be seen between moderate and severe degree （LSD, P =0.757）. Positive linear correlation was existed between the persentages of SIR1 and tumor cells in bone marrow （r =-0.765, P 〈 0.001）. Conclusion As a noninvasive and direct-viewing technique, MRI presents a global view of bone marrow with high sensitivity in detecting bone marrow involvement in lymphoma. To a certain extent, it could be possible to estimate the infiltration degree and evaluation of the tumor burden in bone marrow by quantitative measurement of MRI.