3.0T全身不同成像序列组合对淋巴瘤浸润骨髓的评估价值-现代医学

3.0T全身不同成像序列组合对淋巴瘤浸润骨髓的评估价值

单位：1. 南京医科大学第一临床医学院影像科, 江苏南京 210029;
2. 东南大学附属中大医院放射科, 江苏南京 210009;
3. 东南大学附属中大医院血液科, 江苏南京 210009

分类号：R733.4;R730.44

出版年·卷·期（页码）：2018·46·第十一期（1238-1243）

摘要：

目的：探讨3.0T磁共振成像中联合应用常规MRI T2WI、STIR、T1-mDixon和WBDWI 4种检查技术组合方案行全身成像对淋巴瘤浸润骨髓的临床诊断价值。方法：收集东南大学附属中大医院血液科2016年12月至2018年6月收治的62例恶性淋巴瘤患者，使用Philips Ingenia Ⅱ 3.0T磁共振扫描仪，对患者行冠状位常规T2WI、STIR、T1-mDixon及横断位的WBDWI检查。对全身磁共振成像的4组序列进行以下5种检查不同的组合方案，即仅WBDWI技术（组合一），T2WI联合WBDWI技术（组合二），STIR联合WBDWI技术（组合三），T1-mDixon联合WBDWI技术（组合四），以及T2WI、STIR、T1-mDixon联合WBDWI技术（组合五）。以淋巴瘤浸润骨髓确诊依据为金标准，评价上述5组检查方案对恶性淋巴瘤（ML）浸润骨髓的诊断效能。采用SPSS 18.0统计软件，行配对卡方（McNemar）检验以评价任两个方案间差异有无统计学意义。结果：62例疑似淋巴瘤浸润骨髓的患者，确诊38例。对各组合方案经McNemar检验两两比较结果显示，组合四和组合五之间对ML浸润骨髓诊断的敏感性和准确率，较前3种方案差异有统计学意义（P<0.000 1），两者之间对ML浸润骨髓诊断的特异性也存在显著差异（P<0.05）。结论：对临床疑似淋巴瘤浸润骨髓者，采用T2WI、STIR、T1-mDixon联合WBDWI技术进行全身磁共振检查，大大提高病灶的检出率和准确率，能够指导临床及时调整诊疗方案，具有较高的临床应用前景。

Objective:To explore the clinical value of3.0T magnetic resonance whole-body imaging in the bone marrow infiltration of lymphoma combined with conventional MRI T2WI, STIR, T1-mDixon and WBDWI. Methods:62 patients with malignant lymphoma were collected. These patients were admitted to the Department of Hematology in Zhongda Hospital from December 2016 to June 2018. Using the Philips Ingenia Ⅱ 3.0T magnetic resonance scanner, the coils were used to perform the patient's coronal scan of conventional T2WI, STIR and T1-mDixon sequences, and transverse WBDWI scan. Four sequences for whole-body magnetic resonance imaging (T2WI, STIR, T1-mDixon, WBDWI) were combined in the following five different combinations:Combination 1, only using WBDWI technology; Combination 2, using T2WI combined with WBDWI technology; Combination 3, using STIR combined with WBDWI technology; Combination 4, using T1-mDixon combined with WBDWI technology; Combination 5, using T2WI, STIR and T1-mDixon combined with WBDWI technology. According to the gold standard for the diagnosis of lymphoma bone marrow infiltration, the evaluation scores compared with diagnostic results under different imaging protocols and histopathology results were used to evaluate the diagnostic efficacy of the above five examination combinations for bone marrow infiltration of malignant lymphoma(ML). The Mcnemar test was used. Results:The analyzing results of lymphoma bone marrow infiltration through different combinations of T1-mDixon, T2WI, STIR and WBDWI scanning showed:Of the 62 patients with suspected lymphoma bone marrow infiltration, 35 patients were diagnosed by bone marrow aspiration or biopsy pathology. The results of the McNemar tests between the two groups of the imaging combinations showed that the sensitivity and accuracy of Combination 4 and Combination 5 in the diagnosis of ML bone marrow infiltration weresignificantly different from the other combinations(P<0.000 1), but there was a statistically significant difference between Combination 4 and Combination 5 in the diagnosis specificity of ML bone marrow infiltration (P<0.05). Conclusion:For lymphoma patients with clinically suspected bone marrow infiltration, T2WI, STIR, T1-mDixon and WBDWI techniques may be used for whole body magnetic resonance examination. These imaging combinations could greatly improve the sensitivity and accuracy for detection and may have positive clinical effects on the diagnosis and treatment of lymphoma.

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