摘要
目的采用动态增强MRI（DCE—MRI）分析急性白血病（AL）患者骨髓浸润微循环血流动力学特点及临床意义。方法47例AL患者行快速小角度激发梯度回波（FLASH）序列T1WI冠状面髋部DCE—MRI，分别在腰椎及双侧髂骨设置ROI，绘制时间-信号强度曲线（ETCs），计算最大强化率（Emax）、强化斜率（slope）。读取MR检查近期AL骨髓象中原始细胞所占比例。47例AL患者分为3组：初发未治疗组、初发治疗完全缓解（CR）组及初发治疗未缓解（NR）组。比较AL患者不同部位（椎体及髂骨）骨髓浸润在DCE—MRI的差异；比较3组患者髂骨骨髓浸润Emax、slope值的差异，与骨髓象原始细胞计数对照分析其临床意义。对所获数据分别采用配对资料的t检验、方差分析及Pearson相关性分析。结果47例AL患者髂骨骨髓Emax值（15．70±7．06）比腰椎（11．28±5．52）高，差异具有统计学意义（P〈0．01）；slope值分别为0．82±0．12和0．80±0．09，差异无统计学意义（P〉0．05）。25例初发未治疗组髂骨骨髓Emax和slope分别为17．15±5．75和0．98±0．13，14例初发治疗CR组分别为8．76±3．93和0．26±0．04，8例初发治疗NR组分别为21．62±6．50和1．38±0．02，三组间Emax和slope差异均有统计学意义（P值均〈0．05）；初发治疗CR组的Emax及slope值均低于初发未治疗组和初发治疗NR组（P值均〈0．05）；初发未治疗组Emax及slope值均低于初发治疗NR组，但差异无统计学意义（P〉0．05）。47例AL患者髂骨骨髓的Emax值与骨髓象原始细胞比例（25．6±4．2）％呈正相关（r=0．501，P〈0．05），与slope值无相关性（r=0．235，P〉0．05）。结论DCE—MRI是评估AL患者骨髓浸润微循环血流动力学的有效方法，可望为AL患者预后评价及疗效监测提供有价值的信息。
Objective Using dynamic contrast-enhanced magnetic resonance imaging （DCE-MRI） to evaluate the hemodynamie perfusion characteristics of bone marrow infiltration in patients with acute leukemia （AL）. Methods Forty-seven patients with AL received coronal pelvic T1WI DCE-MRI with fast low angle shot （FLASH） sequence. Among them, 25 were initial onset untreated （IOU） patients, 22 were treated AL patients, including 14 with complete remission （CR） and 8 with non-remission （NR）. The hemodynamie perfusion parameters including maximum percentage of enhancement （Emax） and slope were determined based on enhancement-time curves （ETCs） of iliac and lumbar vertebra. The proportion of marrow myeloblasts was recorded. For all patients, quantitative perfusion parameters of bone marrow infiltration in ilium were compared with those in lumbar. The values of Emax and ES were compared among IOU, CR and NR patients. Correlations between perfusion parameters and histopathological results were assessed. Results In all the 47 patients, the Emax values of bilateral iliac bone marrow （ 15.70 ±7. 06） were slightly higher than that of lumbar bone marrow （ 11.28± 5.52）, and the difference was statistically significant （P 〈 0. 01 ）. There was no significant difference in the slop value between bilateral iliac bone marrow （0. 82 0. 12） and lumbar bone marrow （0. 80 ± 0. 09） （ P 〉 0. 05 ）. In the 25 untreated patients, the Emax and slop values were 17.15 ± 5.75 and 0. 98 ± 0. 13, respectively; in the 14 CR patients, they were 8.76 ± 3.93 and 0. 26 ± 0. 04, respectively, and in the 8 NR patients, they were 21.62 ±6. 50 and 1.38 ± 0. 02, respectively. There was significant difference in the Emax and slop values among the three groups （P 〈0. 05）. Compared with IOU and NR patients, both the Emax and slop values decreased significantly in iliac bone marrow of AL patients with CR （ P 〈 0. 05 ）. There was no signifieant differenee between IOU and NR patients （ P 〉 0.05 ）. A significant positive correlation was found between Emax value of iliac bone marrow and the proportion of marrow myeloblasts （r =0. 501 ,P 〈0. 05）. There was a negative correlation between slop value of iliac bone marrow and the proportion of marrow myeloblasts （ r = 0. 235, P 〉 0. 05）. Conclusions DCE-MRI can be used for evaluating the hemodynamic characteristics of microcirculation of bone marrow infiltration in patients with AL, which can provide useful information in evaluating prognosis and monitoring therapeutic effect.
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2011年第9期817-821,共5页
Chinese Journal of Radiology
基金
山西省青年科技研究基金资助项目（2007021053）
山西省青年学科带头人资助项目（山西省强校工程专项经费晋教财2007271）
山西医科大学博士基金资助项目（200606）
山西医科大学第二医院博士启动基金资助项目（2006012）
关键词
急性白血病
骨髓
浸润
动态增强
磁共振成像
Acute leukemia
Bone marrow
Infiltration
Dynamic contrast enhancement
Magnetic resonance imaging
