摘要 目的：通過觀察急性白血病 治療 前後骨髓的MRI表現和T1及對比度噪聲比（CNR）的測定，對照臨床、病理資料，探討急性白血病骨髓MRI定性和定量診斷價值。材料與 方法 ：選擇經臨床確診為急性白血病的患者38例，緩解組25例，對照組35例進行MRI檢查及T1值和對比度噪聲比（CNR）的測定。結果：急性白血病T1WI ：治療前組38例,腰骶椎、髂骨及股骨近段均表現為信號降低；化療緩解組25例表現為不同程度的信號增高。 T2WI：38例治療前組和25例化療後組各椎體、髂骨、股骨上段呈等信號。外周血B%、骨髓B%、腰椎T1值、腰椎/皮下脂肪CNR、股骨骨髓/皮下脂肪CNR於急性白血病治療前組與正常對照組、治療前組與緩解組間的差異均有顯著性（P<0.05），緩解組與正常對照組間的差異無顯著性（P>0.05），不同細胞類型間的差異無顯著性（ P>0.05）。腰椎T1值於不同性別、年齡組間的差異無顯著性（ P>0.05）。治療前組骨髓B%與腰椎T1值、與腰椎/皮下脂肪CNR，外周血B%與腰椎T1值、與腰椎/皮下脂肪CNR及腰椎T1值與腰椎/皮下脂肪CNR 之間成直線相關（P<0.05）。結論：急性白血病的ＭＲＩ檢查為一種無創性方法，MRI表現具有一定的特徵性，在估計病情的嚴重程度及治療效果的評價簡便實用，為避免多次重複骨髓穿刺檢查以及全面觀察急性白血病骨髓浸潤範圍和程度有著重要的臨床意義。
關鍵詞：急性白血病 磁共振成像（MRI） 診斷 治療
The Vale of MRI in acute leukemia naturally and quantitatively
[Abstract] objective To evaluate MRI diagnosis of bone narrow in acute leukemia by observing MRI appearance and calculating T1 value,CNR(ratio of contrast/noise) in patients before and after chemothrapy, contrasting to materials in clinic and pathology. Materials and methods Thirty-Eight patients, with acute leukemia were examined. Twenty-five patients served as remission group. As control group ,35 healthy volunteers were performed MR examination with identical methods. Serial MR studies include observation of MRI character and measurement of T1 value and CNR in all patients. Result Of all 38 cases of acute leukemia at the time of diagnosis compare with control group: Hypointense signal in T1WI by well-distribute were found in lumbosacral vertebral, iliac, and femur approaching. Isointense signal in T2WI was found in all cases we done. The signal intensity in T1WI tended to normal in all 25 remission cases of acute leukemia. Isointense signal also found in T2WI in remission cases. The difference of T1 value in lumber, CNR in lumber/subcutaneous fat and femur/subcutaneous fat, B% in blood and marrow were significant (P<0.05) among groups of diagnosis and control, diagnosis and remission; but they weren』t significant (p>0.05) between groups of control and remission, and cellulality among ALL, AML, ALL+AML .Positive linear correlation was found among T1 value in lumber and B% in blood, T1 value in lumber and B% in marrow, CNR in lumber/subcutaneous fat and B% in blood, CNR in lumber/subcutaneous fat and B% in marrow, T1 value in lumber and CNR in lumber/subcutaneous fat. There were statistic Significant among them (P<0.05). Conclution MRI is a none-invasive method in check marrow in acute leukemia .The MRI appearance in acute leukemia was convenient and useful especially in estimating the state of illness and monitoring therapeutic efficacy .There was great clinical valuable in acute leukemia to avoid repetition marrow puncture and observe the scope and level of infiltration.
[Key words] acute leukemia; Magnetic resonance imaging (MRI); diagnosis; chemothyrapy.
既往，急性白血病定性及定量的檢查方法為骨髓穿刺塗片或活檢，為有創傷性的檢查。自從磁共振成像儀（MRI）問世並於1980年開始 應用 於臨床以後，由於其能靈敏地反映骨髓組織結構和化學成分的變化，故在一定程度上能從宏觀的圖象改變而反映骨髓微觀分子結構的改變。至今，國外已有較多的 研究 [1~2]，國內只有少數 文獻 報道[3]。本研究旨在結合本地的病例特點，採用大病例組，探討急性淋巴細胞性白血病（ALL）和急性髓細胞性白血病（AML）的MRI表現，並與臨床、病理聯繫，系統而深入進行定性和定量的研究，以期使MRI成為診斷本病和觀察其療效的一種重要手段。
材料與方法
關鍵詞：急性白血病 磁共振成像（MRI） 診斷 治療
The Vale of MRI in acute leukemia naturally and quantitatively
[Abstract] objective To evaluate MRI diagnosis of bone narrow in acute leukemia by observing MRI appearance and calculating T1 value,CNR(ratio of contrast/noise) in patients before and after chemothrapy, contrasting to materials in clinic and pathology. Materials and methods Thirty-Eight patients, with acute leukemia were examined. Twenty-five patients served as remission group. As control group ,35 healthy volunteers were performed MR examination with identical methods. Serial MR studies include observation of MRI character and measurement of T1 value and CNR in all patients. Result Of all 38 cases of acute leukemia at the time of diagnosis compare with control group: Hypointense signal in T1WI by well-distribute were found in lumbosacral vertebral, iliac, and femur approaching. Isointense signal in T2WI was found in all cases we done. The signal intensity in T1WI tended to normal in all 25 remission cases of acute leukemia. Isointense signal also found in T2WI in remission cases. The difference of T1 value in lumber, CNR in lumber/subcutaneous fat and femur/subcutaneous fat, B% in blood and marrow were significant (P<0.05) among groups of diagnosis and control, diagnosis and remission; but they weren』t significant (p>0.05) between groups of control and remission, and cellulality among ALL, AML, ALL+AML .Positive linear correlation was found among T1 value in lumber and B% in blood, T1 value in lumber and B% in marrow, CNR in lumber/subcutaneous fat and B% in blood, CNR in lumber/subcutaneous fat and B% in marrow, T1 value in lumber and CNR in lumber/subcutaneous fat. There were statistic Significant among them (P<0.05). Conclution MRI is a none-invasive method in check marrow in acute leukemia .The MRI appearance in acute leukemia was convenient and useful especially in estimating the state of illness and monitoring therapeutic efficacy .There was great clinical valuable in acute leukemia to avoid repetition marrow puncture and observe the scope and level of infiltration.
[Key words] acute leukemia; Magnetic resonance imaging (MRI); diagnosis; chemothyrapy.
既往，急性白血病定性及定量的檢查方法為骨髓穿刺塗片或活檢，為有創傷性的檢查。自從磁共振成像儀（MRI）問世並於1980年開始 應用 於臨床以後，由於其能靈敏地反映骨髓組織結構和化學成分的變化，故在一定程度上能從宏觀的圖象改變而反映骨髓微觀分子結構的改變。至今，國外已有較多的 研究 [1~2]，國內只有少數 文獻 報道[3]。本研究旨在結合本地的病例特點，採用大病例組，探討急性淋巴細胞性白血病（ALL）和急性髓細胞性白血病（AML）的MRI表現，並與臨床、病理聯繫，系統而深入進行定性和定量的研究，以期使MRI成為診斷本病和觀察其療效的一種重要手段。
材料與方法
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