脊柱多发性骨髓瘤的MR诊断价值

Diagnostic Value of Magnetic Resonance of Multiple Myeloma in the Spine

目的探讨脊柱多发性骨髓瘤(multiple myeloma,MM)的MRI表现,总结其影像特征,提高其MR诊断水平。方法回顾性分析经骨髓穿刺活检证实的脊柱MM 43例的临床及MRI资料,总结其MRI特点,并进行影像学分期与临床分期的比对分析。结果 43例脊柱MM MR扫视到964个椎体,452个椎体受累,其中胸椎受累占56.8%,颈椎受累占13.5%,腰骶椎受累占29.7%。病理性骨折占受累椎体的24.5%。脊柱MM的MRI基本表现为高信号背景下的长T1、长T2信号,在脂肪抑制T2WI序列上呈高信号,增强扫描可表现为不同程度的强化,与正常骨髓对比更明显。不同分型多发性骨髓瘤MRI各有特点:正常型、局灶型、"椒盐"型以临床Ⅰ期常见,弥漫型、混合型以临床Ⅱ、Ⅲ期常见。结论 MR对脊柱MM具有较高的诊断价值。

Objective To explore magnetic resonance （MR） signs of multiple myeloma （MM） in the spine, and sum up characteristics of the images in order to improve the diagnostic level of MR. Methods Clinical and MRI da- ta of 43 patients with MM in the spinal confirmed by bone marrow aspiration was retrospectively analyzed, and MRI char- acteristics were summarized. The comparative analysis between iconography stagings with clinical stages was performed. Results A total of 964 centrums were scanned in the 43 patients with MM in the spinal, in which 452 were involved, in- cluding 56.8% of involvement in thoracic vertebrae, 13.5% in cervical vertebrae, and 29.7% of lumbosacral vertebrae. Pathological fractures accounted for 24.5% of affected vertebral body. Rachial MRI basic signs of MM were the long T1 and T2 signal with hyperintense; it showed hyperintense in T2WI sequences of fat-suppression; the enhancement scanning showed strengthening with varying degrees, especially when it compared with that in the normal bone marrow. Different type of MM had its own MRI features ： normal type, focal type, and the salt and pepper type were more common in clini- cal stage I , while the diffuse type and mixed type were usually found in stages II and III. Conclusion MRI has a high value in diagnosis of MM in the spine.