Baur A, Stäbler A, Steinborn M, Schnarkowski P, Pistitsch C, Lamerz R, Bartl R, Reiser M
Institut für Radiologische Diagnostik, Klinikum Grosshadern, München.
Rofo. 1998 Apr;168(4):323-9. doi: 10.1055/s-2007-1015137.
The aim of this study was to compare various pulse-sequences employing the spine array coil while considering the different infiltration patterns in multiple myeloma, in order to develop a fast and cost effective screening method.
In a prospective study, 50 patients with histologically proven multiple myeloma were examined with the following standardised sequences: T1-weighted SE, T2-weighted FSE, opposed phase GRE, FSE STIR, T1-weighted SE post gadopentate dimeglumine without and with fat saturation. The images were evaluated in a ROC analysis by three radiologists in consensus with a 5-grade scale separatively for diffuse and focal involvement. The gold standard was bone marrow histology in cases of diffuse infiltration and the combination of all sequences with the staging system according to Durie and Salmon.
For focal bone marrow involvement the area under curve was greatest for FSE STIR sequences, in cases of diffuse infiltration the area under curve was superior for unenhanced T1-w SE-Sequenz images. The sensitivity can be increased by contrast material application and signal intensity measurements. A combined focal and diffuse infiltration and a "salt and pepper" pattern can be diagnosed with the combination of T1-w SE-Sequenz and FSE STIR sequences.
With T1-weighted SE-Sequenz sequences pre- and post-contrast and FSE STIR all therapeutical relevant infiltration patterns of plasmocytoma can be identified and bone marrow screening of the spine can be carried out with an acquisition time of 5.58 minutes.
本研究旨在比较使用脊柱阵列线圈的各种脉冲序列，同时考虑多发性骨髓瘤的不同浸润模式，以开发一种快速且经济高效的筛查方法。
在一项前瞻性研究中，对50例经组织学证实的多发性骨髓瘤患者进行了以下标准化序列检查：T1加权SE序列、T2加权FSE序列、反相位GRE序列、FSE STIR序列、注射钆喷酸葡胺前后且有无脂肪抑制的T1加权SE序列。由三位放射科医生对图像进行ROC分析评估，就弥漫性和局灶性受累分别采用5级评分标准达成共识。对于弥漫性浸润病例，金标准是骨髓组织学检查；对于所有序列，则结合Durie和Salmon分期系统。
对于局灶性骨髓受累，FSE STIR序列的曲线下面积最大；对于弥漫性浸润，未增强的T1加权SE序列图像的曲线下面积更优。通过应用对比剂和测量信号强度可提高敏感性。结合T1加权SE序列和FSE STIR序列可诊断局灶性与弥漫性浸润合并存在以及“椒盐”样模式。
采用对比剂前后的T1加权SE序列和FSE STIR序列，可识别浆细胞瘤所有与治疗相关的浸润模式，且脊柱骨髓筛查的采集时间为5.58分钟。
