CAJ | 학술논문

目的：分析骨孤立性浆细胞瘤（SPB）的放射学表现特征，着重探讨 MRI 中4D CE-MRA 及 DWI 的诊断意义。方法：对7例经手术及病理证实的 SPB 患者的临床及放射学资料进行前瞻性分析，重点分析4D CE-MRA、DWI 的特征。结果：7例在 X 线片或 CT 上均呈溶骨性膨胀性骨质破坏，边界清，无骨膜反应，5例骨皮质明显变薄并部分中断，2例骨皮质变薄但仍连续。MRI 所有病例均未见瘤周骨髓水肿，均可见软组织肿块，T1 WI 5例略高信号、2例等信号，T2 WI均以稍高信号为主，夹杂少许灶性高、低信号；增强扫描明显强化，4D CE-MRA 见肿瘤供血动脉显影及肿瘤染色，自动脉早期到静脉期瘤体染色信号逐渐增强；高 b 值 DWI 上病变呈高信号，ADC 图上呈灰黑色较低信号，ADC 均值（0．856±0．059）×10-3 mm2/s，肿块的 ADC 值低于正常肌肉，差异具有统计学意义（t 值为39．55，P ＜0．001）。结论：X 线、CT 和常规 MRI 反映 SPB 的恶性特性有限度，4D CE-MRA、DWI 表现提示其恶性特征，对定性诊断有重要意义。
목적：분석골고립성장세포류（SPB）적방사학표현특정，착중탐토 MRI 중4D CE-MRA 급 DWI 적진단의의。방법：대7례경수술급병리증실적 SPB 환자적림상급방사학자료진행전첨성분석，중점분석4D CE-MRA、DWI 적특정。결과：7례재 X 선편혹 CT 상균정용골성팽창성골질파배，변계청，무골막반응，5례골피질명현변박병부분중단，2례골피질변박단잉련속。MRI 소유병례균미견류주골수수종，균가견연조직종괴，T1 WI 5례략고신호、2례등신호，T2 WI균이초고신호위주，협잡소허조성고、저신호；증강소묘명현강화，4D CE-MRA 견종류공혈동맥현영급종류염색，자동맥조기도정맥기류체염색신호축점증강；고 b 치 DWI 상병변정고신호，ADC 도상정회흑색교저신호，ADC 균치（0．856±0．059）×10-3 mm2/s，종괴적 ADC 치저우정상기육，차이구유통계학의의（t 치위39．55，P ＜0．001）。결론：X 선、CT 화상규 MRI 반영 SPB 적악성특성유한도，4D CE-MRA、DWI 표현제시기악성특정，대정성진단유중요의의。
Objective:To analyze the imaging appearances of solitary plasmacytoma of bone (SPB),emphasized on the evaluation of the diagnostic value of four-dimensional contrast enhanced MR angiography (4D CE-MRA)and MR diffusion weighted imaging (DWI).Methods:The clinical and imaging materials of seven patients with pathology proven SPB were prospectively analyzed,evaluation of the imaging features of 4D CE-MRA and DWI were highlighted.Results:All of the sev-en cases showed solitary expansile osteolytic lesion with well-defined margin,obvious bone cortex thinning and partial dis-continuity,no periosteal reaction was seen on X-ray film or CT.On MRI,peritumoral edema was not found in all cases,an associated soft-tissue mass was apparent,homogeneous slight hyper-(n=5)or iso-(n=2)intensity to muscle were seen on T1-weighted images and hyperintensity on T2-weighted images (n=7),and prominent homogeneous enhancement after ad-ministration of contrast medium.Tumor feeding arteries and tumor staining were seen on 4D CE-MRA,and tumor staining became more obvious with the delaying of time.Tumors showed high signal on DWI at b value of 1000 and grey-black scale on ADC map with the mean ADC value as (0.856 ±0.059)×10 -3 mm2/s,which were lower than those of normal muscle with significant statistic difference (t =39.55,P <0.001 ).Conclusion:Despite the limitations for showing the malignant tumor features of SPB on radiography,CT and routine MRI,characteristics of malignant bone tumor could be assessed on 4D CE-MRA and DWI which are helpful for qualitative diagnosis.