骨肉瘤磁共振成像序列选择的评价

Analysise the Different Pulse Sequences of MR Imaging for Estimating the Extent of Osteosarcoma

目的 研究骨肉瘤患者术前MRI各检查序列对肿瘤髓内侵犯范围判定的精确性及其临床应用价值。方法收集和比较分析本院自1991年-2001年1月的临床及病理资料完整的骨肉瘤患者28例患者术前MRI各序列影像检查仪器为美国Resonex 0.38T磁共振成像机,扫描序列为:自旋回波(SE序列),反转恢复序列(STIR)。所有患者均行增强扫描后T1WI扫描。造影剂为Gd-DTPA 0.1 mmol/kg体重,经肘部浅静脉注射后立即成像。术后病理标本制成切片,进行肿瘤定性分析。结果 MRI成像在骨肉瘤髓内侵犯长径判定上,T2WI、脂肪抑制、增强扫描与T1WI均有显著性差异,在前后径判定上前3种方法与T1WI均无显著性差异,而在左右径判定上,只有脂肪抑制成像与T1WI有显著性差异。结论 SE序列中T1WI(横断位、矢状位、冠状位)应作为对骨肉瘤侵犯范围判定的首选成像方式。

Objective To evaluate the accuracy of preoperative in different pulse sequences of MR imaging for estimat-ing the intraosseous and extraosseous extent of osteosarcoma. Methods 28 patients were examined by a 0.38T MR system before operation. Pulse sequences were unenhanced spin-echo (T1-weighted imaging, T2-weighted imaging),STIR (short-tau inversion recovery) and gadolinium(Gd-DTPA) enhanced spine-echo T1-weighted imaging. The tumor size in different pulse sequences was measured. Results There was significant difference between T1WI and other pulse sequences (T2WI,STIR,contrast-enhanced) in measuring the longitudal intraosseous extent of osteosarcoma,but no significant difference in measuring the P-A dimension of tumors. In measuring the R-L dimension of tumores,significant difference existed only between T1WI and STIR. Conclusion The extent of tumor detected on MRI is more accurate and more close to pathological findings than on X-ray plain films. T1-weighted imaging with axis,saggital and coronal plane should be proceeded in patient with osteosarcoma firstly.