成人急性白血病初诊骨髓MRI及临床应用研究

Bone marrow MRI in adult patients with untreated acute leukemia and its clinical application value

目的 研究成人急性白血病 (acuteleukemia ,AL)患者初诊自然病程状态下骨髓的MRI表现及其临床应用价值。方法 搜集经细胞形态学及免疫表型综合分析确诊的成人AL 5 4例 ,其中髓细胞白血病 (AML) 2 8例、急性淋巴细胞白血病 (ALL) 2 6例 ,行骨盆及股骨中上段骨髓MRI,采用SE序列及短时反转恢复 (STIR)序列行冠状面扫描 ,选取 15例正常志愿者作为对照组。搜集AL患者同期骨髓象及血常规结果与MRI对比分析。结果 患者骨髓MRI表现按浸润程度和范围分为 5级 ,AML患者 2 3(82 % )例属Ⅰ～Ⅲ级 ,5 (18% )例属Ⅳ级 ,无Ⅴ级病例 ;ALL患者 12 (4 6 % )例属Ⅳ级 ,14(5 4% )例属Ⅴ级 ,无Ⅰ～Ⅲ级病例 ,2型患者MRI分级总体的分布差异有非常显著性意义 (U =4.2 33,P <0 0 1)。分别比较 2型AL患者各临床诊断指标 ,显示 2型患者骨髓象白血病细胞计数 (BMT)、外周血白血病细胞计数 (PBT)、外周血白细胞计数 (WBC)之间差异有显著性意义 (t值分别为 4 336、2 0 0 8、3 42 0 ,P值均 <0 0 5 )。MRI分级与临床诊断指标比较 ,两者间具有非常显著的一致性 (U =6 0 99,P <0 0 1)。MRI分级为Ⅳ级的AML患者 ,缓解率较Ⅰ～Ⅲ级者低 (P <0 0 5 ) ,MRI分级为Ⅴ级的ALL患者与Ⅳ级患者缓解率的差异无显著性意义 (P >0 1)。

Objective To observe bone marrow MR imaging of adult acute leukemia patients in first diagnosis and to reveal the rule of bone marrow infiltration and the role of MRI in diagnosing and predicting the prognosis of untreated acute leukemia adult patients. Methods Fifty-four adult acute leukemia patients received MRI after diagnosis relying on FAB subtype and immunophenotyping including 28 cases with AML and 26 cases with ALL. MR imaging was obtained by the short time inversion recovery and T 1W spin echo technique of pelvis and femur at one time. The examining results of morphology and blood routine were collected at the same time. 15 age-matched volunteers were selected as controls. Results MRI showed that bone marrow of all patients were infiltrated by leukemia cells. The MRI appearance was classified into five patterns based on scope of focus. MRI patters from grade 1 to grade 3 were observed in most of patients with AML and in none with ALL, however, all patients with ALL distributed in grade 4 to grade 5. The distribution of patterns had significant difference between AML and ALL (P<0.01). There were significant difference in the counts of PBT and BMT, as well as WBC between AML and ALL (P<0.05, without exception). We divided patients with AML into two groups, one was distributed between grade 1 to grade 3, the other was grade 4. The difference of the two groups was statistically significant (P<0.05) in the rate of remission. There were no statistically significant in ALL. Conclusion MRI can present a more global view of the bone marrow than biopsy material, and therefore may provide a better understanding of disease progression and remission. MRI can estimate the extent of disease in the marrow as a whole. MRI of bone marrow can provide imaging basis in diagnosis and predicting the prognosis for patients with untreated AML.