Plank Christina, Koller Anke, Mueller-Mang Christina, Bammer Roland, Thurnher Majda M
Department of Radiology, Medical University of Vienna, Vienna, Austria.
Neuroradiology. 2007 Dec;49(12):977-85. doi: 10.1007/s00234-007-0275-4. Epub 2007 Oct 19.
Epidural spinal cord compression is one of the most critical emergency conditions requiring medical attention and requires prompt and adequate treatment. The aim of our study was to assess the role of diffusion-weighted magnetic resonance (MR) imaging (DWI) in the diagnosis and differentiation of epidural spinal lesions.
Three patients with epidural lymphoma, two with sarcoma and three with epidural metastatic disease were imaged on a 1.5T MRI unit. DWI was performed using navigated, interleaved, multi-shot echo planar imaging (IEPI). Three region of interest (ROI)-measurements were obtained on corresponding apparent diffusion coefficient (ADC) maps, and the mean ADC value was used for further analysis. The cellularity of tumors was determined as the N/C ratio (nucleus/cytoplasma ratio) from histological samples. The ADC values and N/C ratios of lesions were compared using a Kruskal-Wallis test.
The mean ADC of the lymphomas was 0.66 x 10(-3) mm2/s, that of the sarcomas was 0.85 x 10(-3) mm2/s and the ADC of the metastatic lesions was 1.05 x 10(-3) mm2/s; however, the differences were not statistically significant. Mean N/C ratios in the lymphoma, sarcomas and metastases were 4:1, 2:1, and 2.6:1, respectively, with a statistically significant difference between the groups (p < 0.025).
Although not statistically significant due to the small patient sample, our results clearly show a tendency toward decreased diffusivity in neoplastic lesions with higher cellularity. The data from our study suggest that DWI is a feasible and potentially useful technique for the evaluation of epidural lesions that cause spinal cord compression on a per-patient basis.
硬膜外脊髓压迫是最危急的紧急情况之一，需要医疗关注并要求迅速且充分的治疗。我们研究的目的是评估扩散加权磁共振成像（DWI）在硬膜外脊髓病变的诊断和鉴别诊断中的作用。
对3例硬膜外淋巴瘤患者、2例肉瘤患者和3例硬膜外转移瘤患者在1.5T磁共振成像设备上进行成像。使用导航式、交错、多次激发回波平面成像（IEPI）进行DWI。在相应的表观扩散系数（ADC）图上获得三个感兴趣区（ROI）测量值，并将平均ADC值用于进一步分析。肿瘤的细胞密度通过组织学样本的N/C比（核/细胞质比）来确定。使用Kruskal-Wallis检验比较病变的ADC值和N/C比。
淋巴瘤的平均ADC为0.66×10⁻³mm²/s，肉瘤为0.85×10⁻³mm²/s，转移瘤的ADC为1.05×10⁻³mm²/s；然而，差异无统计学意义。淋巴瘤、肉瘤和转移瘤的平均N/C比分别为4:1、2:1和2.6:1，组间差异有统计学意义（p<0.025）。
尽管由于患者样本量小差异无统计学意义，但我们的结果清楚地显示出细胞密度较高的肿瘤性病变扩散率降低的趋势。我们研究的数据表明，DWI是一种可行且可能有用的技术，可用于逐例评估导致脊髓压迫的硬膜外病变。
