Wasser K, Moehler T, Nosas-Garcia S, Rehm C, Bartl R, Goldschmidt H, Düber C, Kauczor H U, Delorme S
Radiologie, Deutsches Krebsforschungszentrum, Im Neuenheimerfeld 280, 69120 Heidelberg.
Rofo. 2005 Aug;177(8):1116-22. doi: 10.1055/s-2005-858362.
To compare MRI findings and histological plasmacellular infiltration of the bone marrow in patients with multiple myeloma (MM).
Twenty-four patients with different stages of MM underwent 1.5T MRI of the pelvic bone before iliac crest punch biopsy. Precontrast T1wSE and STIR and postcontrast (Gd-DTPA) T1wSE-fatsat were acquired using axial slices. Immediately after the biopsy, T1wSE was repeated to locate the biopsy canal. The corresponding region in the examination before punch biopsy was assessed for bone marrow involvement using a three-point score (0: negative, 1: suspect, 2: definite).
Two patients were not included because the location of the biopsy canal was unclear. Of 7 patients without histological plasmacellular infiltration, MRI was false positive in one case (suspect). Of 15 patients with histological infiltration, MRI was positive in 10 cases (4 suspect, 6 definite). The T1wSE was positive in 9 cases, STIR in 8 cases, and postcontrast T1wSE-fatsat in 7 cases. In 10 of the 15 patients, the infiltration was histologically graded as low (5 - 20 % of bone marrow). In this group, MRI was only positive in 5 cases (3 suspect, 2 definite). Of five patients with the infiltration histologically graded as high (> 20 % of bone marrow), MRI was positive in all cases (1 suspect, 4 definite).
Only advanced bone marrow infiltration in MM can be reliably detected by MRI. None of the used sequences proved to be significantly superior or inferior.
比较多发性骨髓瘤（MM）患者的MRI表现与骨髓组织学浆细胞浸润情况。
24例不同分期的MM患者在髂嵴穿刺活检前行骨盆1.5T MRI检查。采用轴位扫描，获取平扫T1wSE和STIR序列以及增强扫描（钆喷酸葡胺）T1wSE - fatsat序列图像。活检后立即重复T1wSE序列扫描以定位活检通道。根据三点评分法（0：阴性，1：可疑，2：肯定）评估穿刺活检前检查中相应区域的骨髓受累情况。
2例因活检通道位置不清未纳入研究。7例无组织学浆细胞浸润的患者中，MRI有1例假阳性（可疑）。15例有组织学浸润的患者中，MRI阳性10例（4例可疑，6例肯定）。T1wSE序列阳性9例，STIR序列阳性8例，增强扫描T1wSE - fatsat序列阳性7例。15例患者中有10例组织学分级为低浸润（占骨髓的5% - 20%）。该组中，MRI仅5例阳性（3例可疑，2例肯定）。5例组织学分级为高浸润（>骨髓的20%）的患者中，MRI全部阳性（1例可疑，4例肯定）。
MRI仅能可靠检测出MM中晚期骨髓浸润情况。所用序列均未显示出明显的优势或劣势。
