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目的:评价磁共振成像技术在肺癌椎体转移诊断中的作用,回顾性研究肺癌转移灶的病理征象是否能够预测患者的预后。方法:搜集病理及随访证实的肺癌椎体转移患者30例(病理活检证实4例,核素扫描及临床随访证实26例),男17例,女13例,行脊柱MR扫描。均采用常规自旋回波(SE)T1WI、脂肪抑制序列(SPIR)、增强T1WI行矢状及横断面扫描。结果:30例肺癌患者MRI下均可见椎体信号异常。单发灶与多发灶组在原发肿瘤确诊后出现椎体转移灶时间以及椎体转移灶出现后患者的生存时间方面差异有显著性意义(t=9.66、P<0.001;t=2.52、P=0.018);无椎体附件受累与有椎体附件受累两组之间的原发肿瘤确诊后出现椎体转移灶时间、椎体转移灶出现后患者的生存时间差异有显著性意义(t=7.67、P<0.001;t=2.59、P=0.018);无椎旁软组织肿块与有椎旁软组织肿块两组之间的原发肿瘤确诊后出现椎体转移灶时间、椎体转移灶出现后患者的生存时间差异有显著性意义(t=6.43、P<0.001;t=2.86、P=0.010);无脊髓受压与有脊髓受压两组之间的原发肿瘤确诊后出现椎体转移灶时间、椎体转移灶出现后患者的生存时间差异有显著性意义(t=10.87、P<0.001;t=2.93、P=0.041)。结论:MRI能够显示肺癌椎体转移的病理改变过程,MR表现可以前瞻地预测肺癌患者的病程发展。
OBJECTIVE: To evaluate the role of magnetic resonance imaging (MRI) in the diagnosis of vertebral metastases in lung cancer and to study retrospectively whether the pathological signs of metastases in lung cancer can predict the prognosis of patients. Methods: Thirty patients (pathological biopsy confirmed in 4 cases, radionuclide scanning and clinical follow-up confirmed in 26 cases) were collected from pathology and follow-up. There were 17 males and 13 females with MR scan of the spine. Conventional spin echo (SE) T1WI, fat suppression sequence (SPIR), enhanced T1WI sagittal and transverse scan were used. Results: Vertebral body signal abnormalities were seen in all the 30 cases of lung cancer under MRI. There was significant difference between the single tumor group and multiple focus group in the time of vertebral metastasis after the diagnosis of primary tumor and the survival time of patients after vertebral metastasis (t = 9.66, P <0.001; t = 2.52, P = 0.018). The time of vertebral body metastasis after the primary tumor was diagnosed between the two groups without vertebral attachment involvement and the vertebral attachment involvement was significantly different (p = 7.67, P <0.001; t = 2.59, P = 0.018). The time of vertebral body metastasis after the diagnosis of the primary tumor between the paravertebral soft tissue mass and paravertebral soft tissue mass was significant (T = 6.43, P <0.001; t = 2.86, P = 0.010). There was no significant difference in survival time between the two groups (spinal cord compression and spinal cord compression) There was significant difference in the survival time between the time and vertebral metastases (t = 10.87, P <0.001; t = 2.93, P = 0.041). Conclusion: MRI can show the pathological changes of vertebral metastases in lung cancer. MR findings can predict the progression of lung cancer patiently.