Lafforgue P, Clairet D, Chagnaud C, Toussirot E, Daumen-Legre V, Schiano A, Bayle O, Kasbarian M, Acquaviva P C
Service de Rhumatologie, CHU Timone, Marseille.
Rev Rhum Mal Osteoartic. 1992 May;59(5):317-26.
Spinal MRI was performed in 9 multiple myeloma and 2 solitary plasmacytoma, using sagittal, T 1-weighted (TR: 350-550 ms/TE: 15-26 ms) and T 2-weighted (TR: 2,000-2,500 ms/TE: 60-120 ms) sequences, with additional gadolinium injection in 3 cases. MRI features were the following: 1) round, patchy lesions with low T 1 signal highlighted by gadolinium and bright T 2 signal were present in 10 of the 11 patients: all osteolytic lesions seen on plain X-rays corresponded to such lesions and biopsy performed in 4 cases showed massive marrow replacement by plasma cells. 2) overall marrow signal was dramatically decreased in 3 patients (2 of whom had a high tumoral mass). 3) extra-dural compression was present in 4 cases. 4) 25 vertebral compression fractures (10 of whom with a "benign" appearance) and focal fat deposition were seen. 5) postradiation treatment examination seemed predictive of the outcome in the 2 solitary plasmacytomas. MRI proved to be more sensitive than plain X-rays or bone scintigraphy. Number and size of focal tumor-like lesions did not correlate with the low marrow signal appearance. Both correlated poorly with overall tumoral mass but diffuse abnormalities were associated with rapidly fatal outcome in three cases. These features might reflect qualitative rather than quantitative patterns of the disease (nodular or diffuse macroscopic marrow replacement). These findings are in agreement with those of the few previous studies. MRI is valuable for spinal cord damage assessment. It appears less accurate in benign versus malignant vertebral compression fracture determination than it does in bone metastasis. Its prognostic value is still questionable.
对9例多发性骨髓瘤患者和2例孤立性浆细胞瘤患者进行了脊柱磁共振成像（MRI）检查，采用矢状面T1加权（TR：350 - 550毫秒/TE：15 - 26毫秒）和T2加权（TR：2000 - 2500毫秒/TE：60 - 120毫秒）序列，3例患者额外注射了钆剂。MRI表现如下：1）11例患者中有10例存在圆形、斑片状病变，T1信号低，钆剂增强后突出，T2信号高；所有X线平片上所见的溶骨性病变均对应此类病变，4例患者进行的活检显示骨髓被浆细胞大量替代。2）3例患者的整体骨髓信号显著降低（其中2例肿瘤肿块较大）。3）4例患者存在硬膜外压迫。4）观察到25处椎体压缩性骨折（其中10处外观“良性”）和局灶性脂肪沉积。5）放射治疗后的检查似乎可预测2例孤立性浆细胞瘤的预后。MRI被证明比X线平片或骨闪烁显像更敏感。局灶性肿瘤样病变的数量和大小与骨髓低信号表现无关。两者与肿瘤整体肿块的相关性均较差，但弥漫性异常在3例患者中与快速致命结局相关。这些特征可能反映了疾病的定性而非定量模式（结节性或弥漫性宏观骨髓替代）。这些发现与之前少数研究的结果一致。MRI对脊髓损伤评估有价值。在鉴别良性与恶性椎体压缩性骨折方面，其准确性似乎不如在骨转移方面。其预后价值仍存在疑问。
