CAJ | 학술논문

目的分析与成年人急性白血病治疗相关的骨坏死的病因及影像学表现.方法回顾2010年9月至2013年2月发生骨坏死的成年人急性白血病10例临床资料,所有患者均行磁共振成像(MRI)检查确诊.结果 10例患者中,4例为急性淋巴细胞白血病(ALL),均行含大剂量激素的化疗,其中2例行造血干细胞移植(HSCT),1例出现移植物抗宿主病(GVHD)并行激素治疗;6例为急性髓系白血病(AML),所行化疗方案均不含激素,5例患者行HSCT,术后4例出现GVHD并行激素治疗;2例从未接受激素治疗,1例AML-M3患者曾接受4个疗程全反式维甲酸治疗.骨坏死确诊的时间距白血病确诊平均时间为25.1个月.病变多发9例,局部单发1例,受累部位包括股骨、胫骨、髌骨、髂骨、腰椎.X线片检查均为阴性表现;CT检查可见阳性表现,表现为不规则骨质密度减低区伴边缘环状骨质硬化;所有病灶均有典型MRI表现.结论骨坏死是白血病治疗后影响患者生存质量的重要并发症,大剂量激素化疗、HSCT后GVHD的激素治疗、化疗药物的细胞毒性、AML-M3患者全反式维甲酸治疗等均可导致骨坏死的发生.MRI是发现骨坏死最有效的方法,X线片敏感性较差,CT可发现中晚期骨坏死病变,但其表现与非白血病患者骨坏死表现略有不同.
목적 분석여성년인급성백혈병치료상관적골배사적병인급영상학표현.방법 회고2010년9월지2013년2월발생골배사적성년인급성백혈병10례림상자료,소유환자균행자공진성상(MRI)검사학진.결과 10례환자중,4례위급성림파세포백혈병(ALL),균행함대제량격소적화료,기중2례행조혈간세포이식(HSCT),1례출현이식물항숙주병(GVHD)병행격소치료;6례위급성수계백혈병(AML),소행화료방안균불함격소,5례환자행HSCT,술후4례출현GVHD병행격소치료;2례종미접수격소치료,1례AML-M3환자증접수4개료정전반식유갑산치료.골배사학진적시간거백혈병학진평균시간위25.1개월.병변다발9례,국부단발1례,수루부위포괄고골、경골、빈골、가골、요추.X선편검사균위음성표현;CT검사가견양성표현,표현위불규칙골질밀도감저구반변연배상골질경화;소유병조균유전형MRI표현.결론 골배사시백혈병치료후영향환자생존질량적중요병발증,대제량격소화료、HSCT후GVHD적격소치료、화료약물적세포독성、AML-M3환자전반식유갑산치료등균가도치골배사적발생.MRI시발현골배사최유효적방법,X선편민감성교차,CT가발현중만기골배사병변,단기표현여비백혈병환자골배사표현략유불동.
Objective To study the imaging features and possible aetiology of osteonecrosis in adults with acute leukemia.Methods Ten adult patients with acute leukemia for osteonecrosis were reviewed retrospectively.All the lesions were confirmed with MRI.Results Four patients with ALL had accepted chemotherapy contained corticosteroids,two of them were performed HSCT,and one patient suffered GVHD.Six patients with AML had accepted chemotherapy without steroids,five of them were performed HSCT,and four patients suffered GVHD.One patient with AML-M3 had accepted chemotherapy including four courses of ATRA.The mean time between diagnosis of osteonecrosis and leukemia was 25.1 months.Nine cases had multiple lesions,one case had single lesion.The lesions involved femurs,tibias,patellas,iliums,and lumbars.Plain radiographs in six patients can not detect any lesion.Circinal reaction ossification could be detected in CT images of four cases.All the cases had typical feature in MRI.Conclusions In adult leukemia patients,osteonecrosis is a complication after chemotherapy or HSCT.Steroids in chemotherapy protocols or treatment for GVHD,ATRA for APML,chemotherapy-induced direct cytotoxic effect or leukemia itself can be the possible risk factor.For the diagnosis,MRI is the most effective way,and CT features of osteonecrosis in leukemia patients are different from those in non-leukemia patients.