Department of Radiology, Peking University Third Hospital, Beijing, China.
Magn Reson Imaging. 2013 Oct;31(8):1285-91. doi: 10.1016/j.mri.2012.10.006. Epub 2013 Jan 3.
Spinal myeloma and metastatic cancer cause similar symptoms and show similar imaging presentations, thus making them difficult to differentiate. In this study, dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) was performed to differentiate between 9 myelomas and 22 metastatic cancers that present as focal lesions in the spine. The characteristic DCE parameters, including the peak signal enhancement percentage (SE%), the steepest wash-in SE% during the ascending phase and the wash-out SE%, were calculated by normalizing to the precontrast signal intensity. The two-compartmental pharmacokinetic model was used to obtain K(trans) and kep. All nine myelomas showed the wash-out DCE pattern. Of the 22 metastatic cancers, 12 showed wash-out, 7 showed plateau, and 3 showed persistent enhancing patterns. The fraction of cases that showed the wash-out pattern was significantly higher in the myeloma group than the metastatic cancer group (9/9=100% vs. 12/22=55%, P=.03). Compared to the metastatic cancer group, the myeloma group had a higher peak SE% (226%±72% vs. 165%±60%, P=.044), a higher steepest wash-in SE% (169%±51% vs. 111%±41%, P=.01), a higher K(trans) (0.114±0.036 vs. 0.077±0.0281/min, P=.016) and a higher kep (0.88±0.26 vs. 0.49±0.23 1/min, P=.002). The receiver operating characteristic analysis to differentiate between these two groups showed that the area under the curve was 0.798 for K(trans), 0.864 for kep and 0.919 for combined K(trans) and kep. These results show that DCE-MRI may provide additional information for making differential diagnosis to aid in choosing the optimal subsequent procedures or treatments for spinal lesions.
脊柱骨髓瘤和转移性癌症引起的症状相似，影像学表现也相似，因此难以区分。本研究对 9 例脊柱局灶性病变的骨髓瘤和 22 例转移性癌症患者进行了动态对比增强磁共振成像（DCE-MRI）检查。通过与增强前信号强度进行归一化，计算出特征性的 DCE 参数，包括峰值信号增强百分比（SE%）、上升期斜率最大的 SE%和洗脱 SE%。使用双室药代动力学模型获得 Ktrans 和 kep。9 例骨髓瘤均表现为洗脱型 DCE 模式。22 例转移性癌症中，12 例为洗脱型，7 例为平台型，3 例为持续强化型。骨髓瘤组洗脱型病例比例明显高于转移性癌症组（9/9=100% vs. 12/22=55%，P=.03）。与转移性癌症组相比，骨髓瘤组的峰值 SE%更高（226%±72% vs. 165%±60%，P=.044），上升期斜率最大的 SE%更高（169%±51% vs. 111%±41%，P=.01），Ktrans 更高（0.114±0.036 vs. 0.077±0.0281/min，P=.016），kep 更高（0.88±0.26 vs. 0.49±0.23 1/min，P=.002）。用于区分这两组的受试者工作特征分析显示，Ktrans 的曲线下面积为 0.798，kep 的曲线下面积为 0.864，Ktrans 和 kep 的联合曲线下面积为 0.919。这些结果表明，DCE-MRI 可能为鉴别诊断提供额外信息，有助于选择脊柱病变的最佳后续治疗方案。
