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目的:对比MR弥散加权成像(DWI)骨髓对比率与核素骨显像在脊柱转移瘤诊断中的价值。方法:脊柱转移瘤患者40例,21例经骨穿刺检查、13例手术病理证实,其余6例经MRI、CT(或X线)、核素骨显像综合分析和随访证实为转移瘤。均进行b=500s/mm2的DWI扫描,在DWI图上描出感兴趣区(ROI),ROI应尽量包括最典型病灶并避开坏死部分,于病灶ROI上测量异常骨髓信号强度值为SIA,并与相邻椎体ROI上测量的正常骨髓信号强度值SIN比较,骨髓对比率的计算公式为(SIA-SIN)/SIN,测量得出脊柱转移瘤DWI上最典型病灶的骨髓对比率。观察DWI信号变化,测量表观弥散系数(ADC),计算骨髓对比率;并同时进行核素骨显像检查对比。结果:40例脊柱转移瘤患者中,DWI阳性共39例,其中颈椎5例,胸椎14例,腰椎20例;并在病变椎体上发现高信号病灶162个;核素骨显像检查共31例阳性,并在脊柱发现病灶131个。经统计学处理结果:转移瘤的阳性检出率磁共振DWI(97.5%)高于核素骨显像检查(77.5%)(采用两独立样本t检验,P<0.05)。病灶腰椎体的ADC值[(1.37±0.51)×10-3mm2/s]明显高于邻近正常腰椎体[(0.534±0.23)×10-3mm2/s],DWI病灶与邻近正常腰椎体信号强度的骨髓对比率(1.65±1.38)差异大。椎体转移瘤病灶的高信号(162个)和骨髓对比率变化检出比核素骨显像(131个)阳性率高,两者具有显著性差异(P<0.05)。结论:与核素骨显像比较,DWI的高信号或骨髓对比率在脊柱转移瘤的诊断中有一定的优势。
OBJECTIVE: To compare the bone marrow contrast ratio and radionuclide bone imaging of MR diffusion-weighted imaging (DWI) in the diagnosis of spinal metastases. Methods: Forty patients with spinal metastases were examined by bone biopsy. Twenty - one patients were confirmed by biopsy. Thirteen cases were confirmed by pathology. The other six cases were proved to be metastases by comprehensive analysis of MRI, CT (or X - ray) and radionuclide bone imaging. All patients underwent DWI with b = 500s / mm2. The ROI was plotted on the DWI. The ROI should include the most typical lesion and avoid the necrotic part. The abnormal bone marrow signal intensity measured on the ROI of the lesion was SIA. The bone marrow contrast ratio was calculated as (SIA-SIN) / SIN as compared with the normal bone marrow signal intensity (SIN) measured on ROI of adjacent vertebral bodies. The bone marrow contrast ratio of the most typical lesions on DWI was measured. The change of DWI signal was observed, the apparent diffusion coefficient (ADC) was measured and the bone marrow contrast ratio was calculated. At the same time, the comparison of radionuclide bone imaging was performed. Results: Of the 40 patients with spinal metastases, 39 were DWI positive, including 5 cervical spine, 14 thoracic vertebra and 20 lumbar vertebra; 162 high signal lesions were found on the vertebral body; Positive cases, and in the spine found 131 lesions. The results of statistical analysis: the positive detection rate of metastases MRI DWI (97.5%) higher than the radionuclide bone imaging examination (77.5%) (using two independent samples t test, P <0.05). The ADC value of lumbar vertebrae [(1.37 ± 0.51) × 10-3mm2 / s] was significantly higher than that of adjacent normal lumbar vertebra [(0.534 ± 0.23) × 10-3mm2 / s], and the signal intensity of DWI lesion and adjacent normal lumbar vertebra Bone marrow contrast ratio (1.65 ± 1.38) difference is big. High signal intensity (162) and bone marrow contrast ratio of vertebral metastases lesions were higher than that of radionuclide bone imaging (131), with significant difference (P <0.05). Conclusion: Compared with radionuclide bone imaging, the high signal intensity or bone marrow contrast rate of DWI has some advantages in the diagnosis of spinal metastases.