基于全身扩散加权成像和mDIXON Quant技术评估骨髓瘤诱导治疗缓解深度的临床价值

The Application Value of Diffusion Weighted Whole Body Imaging with Background Body Signal Suppression and mDIXON Quant Sequencein Monitoring the Response to Induction Therapy of Multiple Myeloma

目的 探讨全身扩散加权成像(DWIBS)和mDIXON Quant在多发性骨髓瘤局灶性病变(FLs)诱导治疗疗效评估中的应用价值.方法 前瞻性搜集2020年1月至2021年6月本院初诊骨髓瘤患者65例,按照诱导治疗疗效分为深度缓解组42例,非深度缓解组23例.所有患者诱导治疗前后均行全身MRI检查(包括DWIBS﹑mDIXON Quant和STIR序列),利用两独立样本t检验或Mann-Whitney检验对深度缓解组和非深度缓解组治疗前后FLs的数目、FLs最大直径、表观扩散系数(ADC)、脂肪分数(FF)和T2*值进行对比,利用受试者工作特征(ROC)曲线分析不同MRI参数识别诱导治疗疗效的诊断效能,并将诱导治疗疗效影响因素采用多因素Logistic回归分析.结果 治疗前非深度缓解组FLs最大直径明显大于深度缓解组(P=0.002),治疗后FLs数目、FLs最大直径、ADC、FF、T2*值以及ADC变化率、FF变化率、T2*变化率两组差异明显(P均<0.001).FF变化率ROC曲线下面积(AUC)最大,为0.989(0.968,1.000).血肌酐、FLs最大直径是预测诱导治疗后深度缓解的独立影响因素(P均<0.05).结论 DWIBS和mDIXON Quant技术结合ADC﹑FF﹑T2*值的测量可以对骨髓瘤FLs诱导治疗缓解深度进行评估,有助于患者个体化治疗的实施.

Objective To investigate the value of DWIBS and mDIXON Quant in monitoring the response to induction therapy of multiple myeloma focal lesions(FLs).Methods 65 newly diagnosed myeloma patients in our hospital from January 2020 to June 2021 were prospectively collected.According to the effect of induction therapy,they were divided into deep remission group of 42 cases and non-deep remission group of 23 cases.All patients underwent whole-body MRI before and after induction treatment(including DWIBS,mDIXON Quant and STIR sequences).The number of FLs,maximum diameter of FLs,ADC,FF and T_(2)^(*) values of deep remission group and non-deep remission group before and after treatment were compared by two independent sample t-test or Mann Whitney test.ROC curve was used to analyze different MRI parameters to identify the diagnostic efficacy of induction treatment,The influencing factors of induction therapy were analyzed by multivariate Logistic regression.Results Before treatment,the maximum diameter of FLs in the non-deep remission group was significantly larger than that in the deep remission group(P=0.002).After treatment,there were significant differences in the number of FLs,the maximum diameter of FLs,ADC,FF,T_(2)^(*) values,ADC change rate,FF change rate and T_(2)^(*) change rate between the two groups(P<0.001).The area under the ROC curve of FF change rate is the largest,which is 0.989(0.968,1.000).Serum creatinine and the maximum diameter of FLs were independent factors predicting deep remission after induction treatment(P<0.05).Conclusion DWIBS and mDIXON Quant combined with the measurement of ADC,FF and T_(2)^(*) values can evaluate the remission depth of FLs induction therapy for myeloma,which is helpful to the implementation of individualized treatment for patients.