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与放射学骨骼检查相比,全身MRI在浆细胞肿瘤患者骨髓浸润检测中的应用

Whole-body MRI in the detection of bone marrow infiltration in patients with plasma cell neoplasms in comparison to the radiological skeletal survey.

作者信息

Ghanem Nadir, Lohrmann Christian, Engelhardt Monika, Pache Gregor, Uhl Markus, Saueressig Ulrich, Kotter Elmar, Langer Mathias

机构信息

Department of Diagnostic Radiology, University Hospital Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany.

出版信息

Eur Radiol. 2006 May;16(5):1005-14. doi: 10.1007/s00330-005-0055-7. Epub 2006 Feb 4.

Abstract

To compare the diagnostic value of whole-body MRI versus radiological skeletal survey (RSS) in staging patients with plasma cell neoplasms (PCN) and to evaluate the possible therapeutic impact of the replacement of RSS by whole-body MRI. Fifty-four patients with PCN [multiple myeloma (MM), n=47; monoclonal gammopathy of unknown significance (MGUS), n=7] were studied by whole-body MRI and RSS in a monocenter prospective analysis from August 2002 to May 2004. The MRIs were performed using a rolling table platform "AngioSURF" for unlimited field of view with a 1.5-T system (Magnetom Sonata/Maestro Class, Siemens Medical Solutions, Erlangen, Germany). A coronal STIR sequence (TR5500-4230/TE102-94/TI160) was used for imaging of the different body regions, including the head, neck, thorax, abdomen, pelvis and upper and lower extremities. The RSS consisted of eight different projections of the axial and appendicular skeleton. In 41/54 (74%) patients, the results of the whole-body MRI and RSS were concordant. In 11/54 (20%) patients, both imaging techniques were negative. Bone involvement was observed in 30/54 (55%) patients; however, whole-body MRI revealed this more extensively than the RSS in 27/30 (90%) patients with concordant positive imaging findings. In 3/30 (10%) patients, both imaging techniques demonstrated a similar extent of bone marrow infiltration. In 10/54 (19%) patients, the whole-body MRI was superior to RSS in detecting bone marrow infiltration, whereas the RSS was negative. In 3/54 (6%) patients, the RSS was proven to be false positive by the clinical course, whereas the whole-body MRI was truly negative. Whole-body MRI is a fast and highly effective method for staging PCN patients by the use of a rolling table platform. Moreover, it is more sensitive and specific than RSS and reveals bone marrow infiltration and extensive disease more reliably. Therefore, whole-body MRI should be performed as an additional method of exactly staging PCN patients and - with more data in the field - may even prove to be an alternate and more sensitive staging procedure than RSS in PCN patients.

摘要

比较全身MRI与放射学骨骼检查(RSS)在浆细胞肿瘤(PCN)患者分期中的诊断价值,并评估全身MRI替代RSS可能产生的治疗影响。2002年8月至2004年5月,在一项单中心前瞻性分析中,对54例PCN患者[多发性骨髓瘤(MM),n = 47;意义未明的单克隆丙种球蛋白病(MGUS),n = 7]进行了全身MRI和RSS检查。MRI使用“AngioSURF”滚动检查床平台在1.5-T系统(德国埃尔兰根西门子医疗解决方案公司的Magnetom Sonata/Maestro Class)上进行,以获得无限视野。采用冠状面短T1反转恢复(STIR)序列(TR5500 - 4230/TE102 - 94/TI160)对包括头部、颈部、胸部、腹部、骨盆以及上下肢在内的不同身体部位进行成像。RSS包括轴向和附属骨骼的八个不同投照。在54例患者中的41例(74%)中,全身MRI和RSS的结果一致。在54例患者中的11例(20%)中,两种成像技术均为阴性。在54例患者中的30例(55%)中观察到骨受累;然而,在27例(90%)成像结果一致且呈阳性的患者中,全身MRI比RSS更广泛地显示了骨受累情况。在30例患者中的3例(10%)中,两种成像技术显示的骨髓浸润范围相似。在54例患者中的10例(19%)中,全身MRI在检测骨髓浸润方面优于RSS,而RSS为阴性。在54例患者中的3例(6%)中,临床病程证明RSS为假阳性,而全身MRI为真阴性。全身MRI是一种通过使用滚动检查床平台对PCN患者进行分期的快速且高效的方法。此外,它比RSS更敏感、更具特异性,能更可靠地显示骨髓浸润和广泛病变。因此,全身MRI应作为精确分期PCN患者的一种补充方法,并且——随着该领域更多数据的积累——甚至可能被证明是一种比RSS更敏感的PCN患者分期替代方法。

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