Rahmouni A, Divine M, Mathieu D, Golli M, Dao T H, Jazaerli N, Anglade M C, Reyes F, Vasile N
Department of Radiology, Hôpital Henri Mondor, Créteil, France.
AJR Am J Roentgenol. 1993 May;160(5):1049-52. doi: 10.2214/ajr.160.5.8470574.
To determine the efficacy of fat-suppressed sequences and contrast-enhanced MR imaging for the detection of focal spinal lesions caused by multiple myeloma, we obtained MR images in 32 patients with newly diagnosed myeloma who had back pain.
All patients had biopsy-proved myeloma and had MR imaging at the painful level of the spine. Spin-echo T1-weighted, T2-weighted, and short TI inversion-recovery (STIR) images; dynamic ultrafast low-angle shot (turbo-FLASH) images after IV injection of a bolus of paramagnetic contrast material; and contrast-enhanced T1-weighted images were obtained. We qualitatively compared the signal intensities and contrast enhancement of focal lesions with those of the surrounding vertebral bodies.
Multiple lesions were detected in all but two of the 32 patients. On T2-weighted and STIR images, all lesions had homogeneously high signal intensity. On T1-weighted images, the lesions were visible as hypointense areas compared with surrounding bone in all except four patients, in whom the lesions were isointense or hyperintense. All tumor nodules enhanced on turbo-FLASH images obtained in the arterial phase. No additional lesions were seen on STIR or contrast-enhanced images. MR findings resulted in a change in the staging of the disease in one patient and led to prompt treatment in five patients with epidural involvement.
MR imaging appears to be helpful in detecting spinal involvement in patients with multiple myeloma. The diagnosis of spinal lesions is best achieved by using either fat-suppressed or T2-weighted images. Although myeloma lesions enhanced in all patients, contrast material appears to be of no value for the detection of additional lesions.
为了确定脂肪抑制序列和对比增强磁共振成像在检测多发性骨髓瘤引起的局灶性脊柱病变中的有效性，我们对32例新诊断为骨髓瘤且有背痛的患者进行了磁共振成像检查。
所有患者均经活检证实为骨髓瘤，并在脊柱疼痛部位进行了磁共振成像检查。获取了自旋回波T1加权、T2加权和短TI反转恢复（STIR）图像；静脉注射大剂量顺磁性对比剂后的动态超快速低角度激发（turbo-FLASH）图像；以及对比增强T1加权图像。我们定性地比较了局灶性病变与周围椎体的信号强度和对比增强情况。
32例患者中除2例以外均检测到多个病变。在T2加权和STIR图像上，所有病变均呈均匀高信号强度。在T1加权图像上，除4例病变呈等信号或高信号的患者外，所有病变与周围骨质相比均表现为低信号区。所有肿瘤结节在动脉期获得的turbo-FLASH图像上均有强化。在STIR或对比增强图像上未发现其他病变。磁共振成像结果使1例患者的疾病分期发生了改变，并促使5例有硬膜外受累的患者得到了及时治疗。
磁共振成像似乎有助于检测多发性骨髓瘤患者的脊柱受累情况。通过使用脂肪抑制或T2加权图像能最好地实现脊柱病变的诊断。虽然所有患者的骨髓瘤病变均有强化，但对比剂对于检测其他病变似乎没有价值。
