CAJ | 학술논문

目的：探讨椎体骨髓单方向扩散屏气DWI方法，分析急性白血病(AL)患者椎体骨髓浸润DWI的临床应用价值。方法对42例确诊AL患者和15名健康志愿者行胸腰椎矢状面单次激发回波平面DWI (SS-EPI-DWI)序列扫描（b值为0、650 s/mm2），扩散方向为头-足(S/I)、前-后(A/P)和左-右(R/L)方向，每个方向DWI采集时间均为12s，闭气采集。分别在3个方向的ADC图上测量多个椎体骨髓的ADC值，比较3个扩散方向的ADC值的差别。AL患者分为初发未治疗组13例和治疗组29例[初发治疗未缓解(NR)组7例。初发治疗完全缓解(CR)组8例、治疗巩固组14例]。比较不同治疗阶段AL患者ADC值的差异用方差分析、t检验,ADC值与骨髓原始细胞比例的相关性采用Pearson分析。结果 57例受试者362个椎体S/I、A/P和R/L方向的ADC值分别为(0.758±0.009)、(0.732 ±0.009)、(0.758±0.009)×10-3 mm2/s，三者之间ADC值的差异无统计学意义(F＝2.958,P＞0.05)。15名健康志愿者94个椎体ADC值为(0.697 ±0.122)×10-3mm2/s，13例初发未治疗组85个椎体ADC值为(0.592±0.071)×10-3mm2/s,两者差异具有统计学意义(t＝2.568，P＜0.05)；29例治疗组AL患者183个椎体ADC值为(0.796±0.225)×10-3mm2/s,与初发未治疗组比较，差异有统计学意义(t＝ -1.332,P＜0.05)；初发治疗CR组±巩同治疗组共140个椎体ADC值为(0.786±0.184)×10 -3mm2/s,初发治疗NR组43个椎体ADC值为(0.804±0.327)×10-3mm2/s,两者差异无统计学意义（t＝ -0.160,P＞0.05）。初发未治疗组的S/I ADC值与骨髓象原始细胞比例（中位数26.4％，范围7.9％～48.2％）呈线性负相关（r＝ -0.524，P＜0.05）。结论椎体骨髓DWI为各向同性，单方向屏气DWI能提高图像质量。初发AL患者ADC值降低，化疗后ADC值增加，初发组ADC值与骨髓象原始细胞比例呈线性负相关。
목적：탐토추체골수단방향확산병기DWI방법，분석급성백혈병(AL)환자추체골수침윤DWI적림상응용개치。방법 대42례학진AL환자화15명건강지원자행흉요추시상면단차격발회파평면DWI (SS-EPI-DWI)서렬소묘（b치위0、650 s/mm2），확산방향위두-족(S/I)、전-후(A/P)화좌-우(R/L)방향，매개방향DWI채집시간균위12s，폐기채집。분별재3개방향적ADC도상측량다개추체골수적ADC치，비교3개확산방향적ADC치적차별。AL환자분위초발미치료조13례화치료조29례[초발치료미완해(NR)조7례。초발치료완전완해(CR)조8례、치료공고조14례]。비교불동치료계단AL환자ADC치적차이용방차분석、t검험,ADC치여골수원시세포비례적상관성채용Pearson분석。결과 57례수시자362개추체S/I、A/P화R/L방향적ADC치분별위(0.758±0.009)、(0.732 ±0.009)、(0.758±0.009)×10-3 mm2/s，삼자지간ADC치적차이무통계학의의(F＝2.958,P＞0.05)。15명건강지원자94개추체ADC치위(0.697 ±0.122)×10-3mm2/s，13례초발미치료조85개추체ADC치위(0.592±0.071)×10-3mm2/s,량자차이구유통계학의의(t＝2.568，P＜0.05)；29례치료조AL환자183개추체ADC치위(0.796±0.225)×10-3mm2/s,여초발미치료조비교，차이유통계학의의(t＝ -1.332,P＜0.05)；초발치료CR조±공동치료조공140개추체ADC치위(0.786±0.184)×10 -3mm2/s,초발치료NR조43개추체ADC치위(0.804±0.327)×10-3mm2/s,량자차이무통계학의의（t＝ -0.160,P＞0.05）。초발미치료조적S/I ADC치여골수상원시세포비례（중위수26.4％，범위7.9％～48.2％）정선성부상관（r＝ -0.524，P＜0.05）。결론 추체골수DWI위각향동성，단방향병기DWI능제고도상질량。초발AL환자ADC치강저，화료후ADC치증가，초발조ADC치여골수상원시세포비례정선성부상관。
Objective Using single direction dispersion breathless DWI, to analyze the value of DWI for vertebral bone marrow infiltration in patients with acute leukemia (AL). Methods Forty-two patients with AL and 15 healthy volunteers received vertebral sagittal DWI with single shot spin-echo echoplan imaging (SS-SE-EPI) sequence( b value ＝ 0,650 s/mm2) at a GE Signa Excite 1. 5 T scanner with 8 channels body coil. DWI for all patients were performed from three directions, including from superior to inferior (S/I), from anterior to posterior (A/P) and from right to left (R/L). The apparent diffusion coefficient (ADC) value was measured on ADC map from each direction using GE-Function tool DWI software. Forty two patients consisted of 13 onset with untreated patients and 29 treated patients (7 nonremission,8 complete remission and 14 consolidation therapy). The ADC values among the three diffusion directions were compared. Analysis of variance and t test were used to compare the ADC values in different AL stages, Pearson correlation analysis was used to analyze the correlation between ADC values and the percentage of bone marrow progenitor cells. Results The ADC values from S/I, A/P and R/L of 362 vertebras in the 57 subjects are (0. 758 ±0. 009) × 10-3 mm2/s, (0. 732 ±0. 009) × 10 -3 mm2/s and (0. 758 ±0. 009) × 10 -3 mm2/s, respectively. There is no statistical significance( F ＝ 2. 958, P ＞ 0. 05 ).The ADC values from S/I of 94 vertebras in 15 healthy volunteers is (0. 697 ± 0. 122) × 10 -3 mm2/s, of 85 vertebras in 13 untreated AL patients is (0. 592 ±0. 071 ) × 10-3mm2/s. There is statistical significance between them ( t ＝ 2. 568, P ＜ 0. 05 ) ; The ADC value of 183 vertebras in 29 treated AL patients [ ( 0. 796 ±0. 225 ) × 10-3mm2/s]is higher than that in untreated patients with statistical significance (t ＝ -1. 332,P ＜0. 05). One hundred and forty vertebras in patients with complete remission and consolidation therapy were [ (0. 786 ±0. 184) × 10-3 mm2/s],and 43 vertebras in patients with non-remission(NR) [ (0. 804 ±0. 327 ) × 10 - 3 mm2/s], there was not statistical significance between them ( t ＝ - 0. 160, P ＞ 0. 05 ). The ADC values from S/I direction of untreated patients showed significant negative correlation with the proportion of the blast cell in the bone marrow ( median value 26. 4％. Min 7.9％, Max 48. 2％ ) ( r ＝- 0. 524, P ＜ 0. 05 ). Conclusions DWI of vertebral bone marrow is isotropy. ADC value is a non-invasive and quantitative index for evaluating the pathogenetic condition of AL.