Avrahami E, Tadmor R, Kaplinsky N
Edith Wolfson Hospital, Tel Aviv, Israel.
Spine (Phila Pa 1976). 1993 Oct 1;18(13):1812-5. doi: 10.1097/00007632-199310000-00017.
Fifty patients with proven multiple myeloma (MM) underwent magnetic resonance (MR) examination of entire spine in sagittal view using T1-weighted image (T1), T2-weighted image (T2), and T2-weighted gradient echo (GE). In 18 patients, the myelomatous foci were hyperintensive in GE and T2 and hypointensive in T1. They corresponded with osteolytic lesions in computed tomography (CT) scan. In another 16 patients with MM, the hyperintensive vertebral foci demonstrated by GE, corresponded with unhomogenic pattern of the vertebral bone marrow in T1 and T2, and insignificant computed tomography (CT) scan. Needle biopsy confirmed histologically the diagnosis MM of involved vertebra in all of them. The vertebral bone marrow had lower signal intensity in GE, which ensured a good contrast between the myelomata and the uninvolved bone marrow. Practically GE enabled the radiologic diagnosis of the spine in 16 patients. It also can prevent a diagnostic pitfall when a fatty focus is suspicious for myeloma in T2 and its demonstration in T1 is poor. Fatty foci were demonstrated in a control group, which included 20 elderly patients who had no history of malignancy. The fatty foci had lower signal intensity in GE and different from the hyperintensive myelomata. Gadolinium diethylene triamine pentaocetic acid (Gd-DTPA) which was administered intravenously in three patients with spinal MM offered no advantage and obscured the lesions.
50例确诊为多发性骨髓瘤（MM）的患者接受了全脊柱矢状位磁共振（MR）检查，使用了T1加权像（T1）、T2加权像（T2）和T2加权梯度回波（GE）序列。18例患者的骨髓瘤病灶在GE和T2序列上呈高信号，在T1序列上呈低信号。这些病灶与计算机断层扫描（CT）中的溶骨性病变相对应。另外16例MM患者中，GE显示的椎体高信号病灶与T1和T2序列中椎体骨髓的不均匀模式相对应，且CT扫描无明显异常。经皮穿刺活检在组织学上证实了所有受累椎体均为MM。椎体骨髓在GE序列上信号强度较低，这确保了骨髓瘤与未受累骨髓之间有良好的对比度。实际上，GE能够对16例患者进行脊柱的影像学诊断。当T2序列中脂肪性病灶疑似骨髓瘤而T1序列显示不佳时，它还可以避免诊断陷阱。在一个对照组中发现了脂肪性病灶，该对照组包括20例无恶性肿瘤病史的老年患者。脂肪性病灶在GE序列上信号强度较低，与高信号的骨髓瘤不同。对3例脊柱MM患者静脉注射钆喷酸葡胺（Gd-DTPA）未显示出优势，反而掩盖了病变。
