Whole-body diffusion-weighted MR imaging in diagnosis of metastatic tumor
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摘要: 目的 探讨磁共振全身扩散加权成像(whole body diffusion weighted imaging,WBDWI)对转移性肿瘤检出、诊断和疗效评估的应用价值。 方法 使用GE Signa HDxt 3.0 T磁共振成像仪,对2013年5月-2016年6月在温州医科大学附属第二医院经病理证实的38例恶性肿瘤全身多发转移患者行WBDWI检查,采用双盲法由2位副主任医师对阳性病灶进行分析、诊断,在表观扩散系数(apparent diffusion coefficient,ADC)图像上选取统一的病灶感兴趣区(region of interest,ROI)测量ADC值。 结果 38例转移瘤患者均进行了全身WBDWI检查,其中2例做过4次、2例做过2次。WBDWI图像上转移瘤均表现为全身多处异常信号灶,包括全身多发淋巴结肿大38例,肝脏多发异常信号灶13例、单发5例,脾脏异常信号灶3例,肾上腺肿块7例,肺部结节10例,椎体、骨盆、肱骨、肩胛骨、胸骨、肋骨等弥漫性骨髓浸润改变24例。WBDWI图像病灶表现为结节状、斑片状高信号,"类PET"翻转图像及ADC图像呈低信号。4例复查病例中,2例显示病灶减少和DWI信号强度降低,ADC值升高(疗效佳),1例病灶增多(疗效不佳),MR信号强度未见明显变化,1例病灶数目、信号强度无变化。 结论 WBDWI作为一种全身功能成像技术,对转移性肿瘤及病变范围的综合评价具有一定意义。Abstract: Objective To investigate the role of whole-body diffusion-weighted imaging (WBDWI) in the detection,diagnosis and assessment of curative effect of metastatic tumors. Methods WBDWI by GE Signa HD xt 3.0 T MR Scanner was performed in 38 patients with metastatic tumor.The positive results were analyzed and diagnosed by two deputy chief physicians with double-blind method,the apparent diffusion coefficient (ADC) values of the lesions were measured on ADC imaging,and the region of interest (ROI) was 20 mm2. Results A total of 38 patients with metastatic tumor were examined by WBDWI,of which,2 cases had been done for 4 times,and another 2 had been done for 2 times.The WBDWI imaging of metastatic tumors showed multiple abnormal signal lesions in the whole body,including 38 cases of multiple lymph nodes enlargement in the body,13 cases of multiple abnormal signals and 5 of solitary in liver,3 in spleen and 7 in adrenal glands,10 in lung nodules,and the diffuse infiltration of bone marrow of vertebrae,pelvis,humerus,scapula,sternum and ribs in 24 cases.The lesions showed nodular and patchy hyper-intensity on WBDWI imaging,hypo-intensity on flipped imaging of WBDWI and ADC imaging.Of 4 cases with follow-up examination after the treatment,2 showed that the number of lesions reduced and the signal intensity decreased on DWI imaging,and the ADC values increased (good curative effect),one showed that the number of lesions increased (poor curative effect),but no significant changes in signal intensity,another one was no significant change in the number of lesions and signal intensity. Conclusion As one systemic functional MR-imaging technology,WBDWI has a certain significance in the comprehensive evaluation of metastatic tumors and lesions.
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