多发性骨髓瘤的全身磁共振成像：不同MRI序列在评估不同生长模式中的比较

Whole-body MRI of multiple myeloma: comparison of different MRI sequences in assessment of different growth patterns.

作者信息

Weininger Markus, Lauterbach Brigitte, Knop Stefan, Pabst Thomas, Kenn Werner, Hahn Dietbert, Beissert Matthias

机构信息

Department of Radiology, University Hospital of Wuerzburg, Wuerzburg, Germany.

出版信息

Eur J Radiol. 2009 Feb;69(2):339-45. doi: 10.1016/j.ejrad.2007.10.025. Epub 2007 Dec 21.

DOI:10.1016/j.ejrad.2007.10.025

PMID:18096344

Abstract

PURPOSE

To determine sensitivity, specificity and inter-observer variability of different whole-body MRI (WB-MRI) sequences in patients with multiple myeloma (MM).

METHODS AND MATERIALS

WB-MRI using a 1.5T MRI scanner was performed in 23 consecutive patients (13 males, 10 females; mean age 63+/-12 years) with histologically proven MM. All patients were clinically classified according to infiltration (low-grade, n=7; intermediate-grade, n=7; high-grade, n=9) and to the staging system of Durie and Salmon PLUS (stage I, n=12; stage II, n=4; stage III, n=7). The control group consisted of 36 individuals without malignancy (25 males, 11 females; mean age 57+/-13 years). Two observers independently evaluated the following WB-MRI sequences: T1w-TSE (T1), T2w-TIRM (T2), and the combination of both sequences, including a contrast-enhanced T1w-TSE with fat-saturation (T1+/-CE/T2). They had to determine growth patterns (focal and/or diffuse) and the MRI sequence that provided the highest confidence level in depicting the MM lesions. Results were calculated on a per-patient basis.

RESULTS

Visual detection of MM was as follows: T1, 65% (sensitivity)/85% (specificity); T2, 76%/81%; T1+/-CE/T2, 67%/88%. Inter-observer variability was as follows: T1, 0.3; T2, 0.55; T1+/-CE/T2, 0.55. Sensitivity improved depending on infiltration grade (T1: 1=60%; 2=36%; 3=83%; T2: 1=70%; 2=71%; 3=89%; T1+/-CE/T2: 1=50%; 2=50%; 3=89%) and clinical stage (T1: 1=58%; 2=63%; 3=79%; T2: 1=58%; 2=88%; 3=100%; T1+/-CE/T2: 1=50%; 2=63%; 3=100%). T2w-TIRM sequences achieved the best reliability in depicting the MM lesions (65% in the mean of both readers).

CONCLUSIONS

T2w-TIRM sequences achieved the highest level of sensitivity and best reliability, and thus might be valuable for initial assessment of MM. For an exact staging and grading the examination protocol should encompass unenhanced and enhanced T1w-MRI sequences, in addition to T2w-TIRM.

摘要

目的

确定不同全身MRI（WB-MRI）序列在多发性骨髓瘤（MM）患者中的敏感性、特异性及观察者间变异性。

方法与材料

对23例经组织学证实的MM患者（13例男性，10例女性；平均年龄63±12岁）使用1.5T MRI扫描仪进行WB-MRI检查。所有患者根据浸润情况（低级别，n = 7；中级，n = 7；高级别，n = 9）及Durie和Salmon PLUS分期系统（I期，n = 12；II期，n = 4；III期，n = 7）进行临床分类。对照组由36例无恶性肿瘤的个体组成（25例男性，11例女性；平均年龄57±13岁）。两名观察者独立评估以下WB-MRI序列：T1w-TSE（T1）、T2w-TIRM（T2）以及两者序列的组合，包括脂肪饱和的对比增强T1w-TSE（T1+/-CE/T2）。他们必须确定生长模式（局灶性和/或弥漫性）以及在描绘MM病变时提供最高置信度的MRI序列。结果按每位患者计算。

结果

MM的视觉检测情况如下：T1，65%（敏感性）/85%（特异性）；T2，76%/81%；T1+/-CE/T2，67%/88%。观察者间变异性如下：T1，0.3；T2，0.55；T1+/-CE/T2，0.55。敏感性根据浸润级别（T1：1级 = 60%；2级 = 36%；3级 = 83%；T2：1级 = 70%；2级 = 71%；3级 = 89%；T1+/-CE/T2：1级 = 50%；2级 = 50%；3级 = 89%）和临床分期（T1：I期 = 58%；II期 = 63%；III期 = 79%；T2：I期 = 58%；II期 = 88%；III期 = 100%；T1+/-CE/T2：I期 = 50%；II期 = 63%；III期 = 100%）有所提高。T2w-TIRM序列在描绘MM病变方面具有最佳可靠性（两位读者的平均值为65%）。