小儿常见血液病的骨髓MRI与磁共振氢质子波谱分析

Magnetic resonance imaging and spectroscopy of the bone marrow in children with common hematological diseases

目的探讨小儿常见血液病骨髓受侵的MRI与磁共振氢质子波谱（1H-MRS）表现。方法收集温州医学院附属第二医院2007年9月至2010年9月儿童血液科收治的初发血液病35例，年龄2～14岁，男16例、女19例，包括经骨髓穿刺活检证实的急性白血病26例、再生障碍性贫血6例、其他类型长期贫血3例（地中海贫血2例、自身免疫性溶血性贫血1例）及正常对照组30名，均行腰椎、髂骨骨髓MRI及。H-MRS检查。扫描序列包括T1WI、T2WI、脂肪抑制短时反转恢复脉冲序列（STIR）及1H—MRS。分析各组椎体、髂骨的骨髓信号及波谱特征，计算感兴趣区相对脂肪含量（FF％）。结果所有病例依据骨髓增生状态分为2种类型：I型骨髓增生活跃型29例（包括急性白血病及其他类型长期贫血），表现为T。WI呈均匀低信号，T2wI呈均匀等低信号，STIR呈均匀高或稍高信号，1H．MRS特征为水峰高耸，脂峰低平或消失；急性白血病组L4椎体FF％值为O％，左侧髂骨FF％值0％，其他类型长期贫血组L4椎体FF％值为5．02％，左侧髂骨FF％值为3．70％。Ⅱ型骨髓增生抑制型6例（再生障碍性贫血），表现为T1WI呈均匀或不均匀高信号，T2WI呈均匀或不均匀高信号，STIR呈均匀或不均匀低信号，1H—MRS特征为脂峰高耸，水峰低平或消失；L4椎体FF％值74．69％，左侧髂骨FF％值91．51％。结论骨髓MRI及1H-MRS可作为评价小儿常见血液病骨髓增生状态的无创伤检查方法。

Objective To evaluate the magnetic resonance （MR） imaging and proton magnetic resonance spectroscopy （IH-MRS） in the diagnosis of pediatric hematological diseases. Methods A total of 35 cases with pediatric hematological diseases were confirmed by bone marrow puncturing. There were acute leukemia （ n = 26）, aplastic anemia （ n = 6）, thalassemia （ n = 2） and autoimmune hemolytic anemia （n = 1 ）. All cases and thirty age-marched healthy children underwent MR imaging （T1WI, T2WI, STIR） and 1 H-MRS of lumber spine and ilium. The lumber spines and iliums were studied by observation of MR imaging and calculation of fat fraction （ FF% ）. Results Two patterns were classified by MR imaging and 1H-MRS in lumber spines and iliums of all cases. Pattern 1 ： hyperplasia of bone marrow （BM）. There were acute leukemia （ n = 26 ）, thalassemia （ n = 2 ） and autoimmune hemolytic anemia （ n = 1 ） . The manifestations included homogeneous low signal intensity （SI） on T1WI, homogeneous low SI on T2WI, high SI on STIR and high water peak and low fat peak on 1H-MRS. The FF%s of regions of interest （ROI） in lumber 4s and left iliums of 26 cases with acute leukemia were 0%, of 3 cases with thalassemia or autoimmune hemolytic anemia were 5.02% and 3.70%. Patten 2 ： inhibition of BM. There were 6 cases of aplastic anemia. The manifestations included homogeneous or inhomogeneous high SI on T1WI and T2WI, homogeneous or inhomogeneous low SI on STIR, and low water peak and high fat peak on 1 H-MRS. FF% s of ROI in lumber 4s and left iliums for 6 cases of aplastic anemia were 74.69% and 91.51%. FF% in all groups had significant differences according to the Mann-Whitney test （ P 〈 0. 05 ）. Conclusion MR imaging and 1 H-MRS may serve as a noninvasive method for checking hematopoietic status of bone marrow in pediatric hematological diseases.