Ling Zhiyu, Xia Yingyi, Wang Qiuxia
Department of Radiology, The First People's Hospital of Yongkang, Yongkang, Zhejiang 321300, P.R. China.
Department of Radiology, The Tongji Medical College Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China.
Oncol Lett. 2020 Jun;19(6):3851-3858. doi: 10.3892/ol.2020.11513. Epub 2020 Apr 6.
At present, MRI is the primary choice of examination for the diagnosis of thoracic extramedullary hemopoiesis. When thoracic extramedullary hemopoiesis presents as posterior mediastinum masses in specific clinical contexts, the diagnosis is not challenging. Other radiological presentations may be more difficult for diagnosis and require biopsy. Needle biopsy is typically preferred for the diagnosis of extramedullary hemopoiesis however, the high vascularization of tissues is one of the complications of this method thus, it is avoided. The aim of the present study was to compare the diagnostic parameters of CT with MRI for the diagnosis of thoracic extramedullary hemopoiesis in patients with leukemia, with an open lung biopsy as a reference standard. Chest CT, chest MRI and open lung biopsy data from a total of 912 patients with leukemia with a sign(s) and symptoms of suspected paravertebral and/or pulmonary extramedullary hemopoiesis were reviewed. In the present study, thoracic extramedullary hemopoiesis was defined as diffusivity of both lung fields being increased compared with the blood pool and no other abnormal focal of lungs being increased compared with the blood pool. The beneficial score was calculated for CT and MRI and plotted for the decision making of irradiation. With respect to open lung biopsy, MRI had a higher sensitivity compared with CT (0.865 vs. 0.809; P<0.0001; q=1691) however, CT had a higher accuracy compared with MRI (0.833 vs. 0.733; P<0.0001; q=3020). The low rate of overdiagnosis was observed for both methods for the detection of thoracic extramedullary hemopoiesis however, the working area for detecting thoracic extramedullary hemopoiesis at least once in images was higher for MRI compared with CT. CT and MRI both have diagnostic importance in the detection of thoracic extramedullary hemopoiesis in patients with leukemia however, chest MRI misdiagnoses the condition while CT can confirm it (level of evidence, 3).
目前，MRI是诊断胸段髓外造血的主要检查手段。当胸段髓外造血在特定临床情况下表现为后纵隔肿块时，诊断并不困难。其他放射学表现可能更难诊断，需要进行活检。针吸活检通常是诊断髓外造血的首选方法，然而，组织的高血管化是该方法的并发症之一，因此应避免使用。本研究的目的是比较CT与MRI对白血病患者胸段髓外造血的诊断参数，并以开胸肺活检作为参考标准。回顾了总共912例有疑似椎旁和/或肺部髓外造血体征和症状的白血病患者的胸部CT、胸部MRI和开胸肺活检数据。在本研究中，胸段髓外造血的定义为双肺野与血池相比扩散系数增加，且肺部无其他与血池相比异常的局灶性增加。计算CT和MRI的有益评分并绘制图表以供放疗决策。关于开胸肺活检，MRI的敏感性高于CT（0.865对0.809；P<0.0001；q=1691），然而，CT的准确性高于MRI（0.833对0.733；P<0.0001；q=3020）。两种方法检测胸段髓外造血的过度诊断率均较低，然而，MRI在图像中至少检测到一次胸段髓外造血的工作区域高于CT。CT和MRI在检测白血病患者胸段髓外造血方面均具有诊断重要性，然而，胸部MRI会误诊该疾病，而CT可以确诊（证据级别，3）。
