Meyer James S, Siegel Marilyn J, Farooqui Saleem O, Jaramillo Diego, Fletcher Barry D, Hoffer Fredric A
Department of Radiology, Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA.
Pediatr Radiol. 2005 Aug;35(8):778-85. doi: 10.1007/s00247-005-1470-2. Epub 2005 May 10.
MRI is an effective tool in evaluating bone marrow metastases. However, no study has defined which MRI sequences or image characteristics best correlate with bone-marrow metastases in neuroblastoma.
To identify and refine MRI criteria and sequence selection for the diagnosis of bone-marrow metastases in children with neuroblastoma.
Ninety-one children (mean age: 3.2 years; standard deviation: 2.8 years) enrolled in the RDOG IV study participated in our study. Forty-five children had bone metastases determined by bone-marrow aspiration or biopsy (n=4), radionuclide imaging (n=2), or both (n=39). Spine lesions were characterized using coronal T1-weighted (T1W) sagittal short tau inversion recovery (STIR) and coronal gadolinium-enhanced T1-weighted (GAD) MR sequences. Contingency table analysis was performed to determine which MRI sequences and characteristics were associated with metastases. The MRI criteria for metastatic disease were then developed for each imaging sequence. The sensitivity, specificity, predictive values, and accuracy of these criteria were determined for the whole group, children younger than 12 months old, and children 12 months and older.
The MR characteristics that had significant (P<or=0.05) associations with metastases were homogeneous low T1-signal intensity, homogeneous high STIR-signal intensity, and heterogeneous pattern on T1, STIR, or GAD. Homogeneous low T1-signal had the highest sensitivity (88%), but a specificity of 62% for detecting metastases. A heterogeneous pattern on GAD was highly specific (97%), but relatively insensitive (65%) for detecting metastases. These MR characteristics were most accurate in children 12 months and older.
The combination of non-contrast-enhanced T1W and GAD sequences can be used to determine the presence of spinal metastases in children with neuroblastoma, particularly those children who are 1 year and older.
磁共振成像（MRI）是评估骨髓转移的有效工具。然而，尚无研究明确哪种MRI序列或图像特征与神经母细胞瘤的骨髓转移最相关。
确定并完善用于诊断神经母细胞瘤患儿骨髓转移的MRI标准及序列选择。
参与RDOG IV研究的91名儿童（平均年龄：3.2岁；标准差：2.8岁）参与了我们的研究。45名儿童通过骨髓穿刺或活检（n = 4）、放射性核素成像（n = 2）或两者（n = 39）确定有骨转移。使用冠状位T1加权（T1W）、矢状位短tau反转恢复（STIR）和冠状位钆增强T1加权（GAD）MR序列对脊柱病变进行特征描述。进行列联表分析以确定哪些MRI序列和特征与转移相关。然后针对每个成像序列制定转移疾病的MRI标准。确定了这些标准对整个组、12个月以下儿童以及12个月及以上儿童的敏感性、特异性、预测值和准确性。
与转移有显著（P≤0.05）关联的MR特征为均匀低T1信号强度、均匀高STIR信号强度以及T1、STIR或GAD上的不均匀模式。均匀低T1信号对检测转移的敏感性最高（88%），但特异性为62%。GAD上的不均匀模式具有高度特异性（97%），但对检测转移相对不敏感（65%）。这些MR特征在12个月及以上儿童中最为准确。
非增强T1W和GAD序列的组合可用于确定神经母细胞瘤患儿脊柱转移的存在，尤其是1岁及以上的儿童。
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