Yoon Min A, Hong Suk-Joo, Lee Chang Hee, Kang Chang Ho, Ahn Kyung-Sik, Kim Baek Hyun
1 Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
2 Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
Acta Radiol. 2017 Oct;58(10):1260-1268. doi: 10.1177/0284185116688380. Epub 2017 Jan 19.
Background High cumulative radiation dose in cancer patients warrants systemic examination of possible changes in bone marrow. Purpose To assess retrospectively changes in vertebral bone marrow diffusion and perfusion using intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) in hepatocellular carcinoma (HCC) patients after exposure to radiation from diagnostic imaging and interventional procedures. Material and Methods A total of 21 IVIM-DWI sets in 20 HCC patients, consisting of baseline and follow-up liver magnetic resonance imaging (MRI) with an interval less than 100 days, were reviewed after varying levels of radiation exposure from transarterial chemoembolization (TACE), multiphase liver CT, and abdominal radiography. IVIM parameters (apparent diffusion coefficient [ADC], true diffusion coefficient [D], pseudodiffusion coefficient [D*], and perfusion fraction [PF]) of vertebral bone marrow were analyzed for significant differences between baseline and follow-up MRI using Wilcoxon signed-rank test, and for correlations with cumulative effective dose, as well as time interval between last radiation exposure and follow-up MRI using Spearman's correlation. Results Compared to baseline MRI, ADC, D*, and PF significantly decreased on follow-up MRI (ADC: median [interquartile range], 0.405 × 10 mm/s [0.364-0.477] versus 0.390 [0.348-0.461]; D*: 24.011 [18.141-29.584] versus 20.815 [15.022-28.347]; PF: 10.960% [8.828-12.985] versus 9.125 [8.606-12.803]) ( P < 0.05). There was no significant difference in D ( P = 0.807). Cumulative effective dose was moderately correlated with decrease in D* (r = 0.434). In addition, longer intervals between last exposure and follow-up MRI showed negative correlations with changes in D and ADC (r = -0.352 and -0.333, respectively). Conclusion Vertebral bone marrow diffusion and perfusion parameters were significantly changed after exposure to medical radiation.
癌症患者的高累积辐射剂量需要对骨髓的可能变化进行系统检查。目的：回顾性评估肝细胞癌（HCC）患者在接受诊断性成像和介入性操作的辐射后，使用体素内不相干运动扩散加权成像（IVIM-DWI）对椎体骨髓扩散和灌注的变化。材料与方法：回顾了20例HCC患者的21组IVIM-DWI数据，包括基线和间隔小于100天的随访肝脏磁共振成像（MRI），这些患者接受了不同程度的经动脉化疗栓塞（TACE）、多期肝脏CT和腹部X线摄影的辐射。使用Wilcoxon符号秩检验分析椎体骨髓的IVIM参数（表观扩散系数[ADC]、真实扩散系数[D]、伪扩散系数[D*]和灌注分数[PF]）在基线和随访MRI之间的显著差异，并分析其与累积有效剂量以及最后一次辐射暴露与随访MRI之间的时间间隔的相关性，采用Spearman相关性分析。结果：与基线MRI相比，随访MRI时ADC、D和PF显著降低（ADC：中位数[四分位间距]，0.405×10⁻³mm²/s[0.364 - 0.477]对0.390[0.348 - 0.461]；D：24.011[18.141 - 29.584]对20.815[15.022 - 28.347]；PF：10.960%[8.828 - 12.985]对9.125[8.606 - 12.803]）（P＜0.05）。D无显著差异（P = 0.807）。累积有效剂量与D*的降低呈中度相关（r = 0.434）。此外，最后一次暴露与随访MRI之间的间隔时间越长，D和ADC的变化呈负相关（r分别为-0.352和-0.333）。结论：医疗辐射暴露后椎体骨髓扩散和灌注参数发生显著变化。
