全身低剂量CT在多发性骨髓瘤临床应用中的初步研究

发布时间：2018-05-25 23:19

本文选题：多发性骨髓瘤 + 低剂量　；参考：《山西医科大学》2017年硕士论文

【摘要】：目的:探讨全身低剂量CT扫描在多发性骨髓瘤(multiple myeloma,MM)临床应用中的价值,为MM的诊断提供一种新思路,评估MM的病情严重程度及预后。方法:连续收集2015年12月至2017年2月首诊于我院经确诊为MM患者41例。患者均进行全身低剂量计算机断层扫描(whole-body low-dose computerized tomography,WBLDCT)扫描,扫描管电压为140KV,管电流50mA。并使用宝石计算机断层扫描(computerized tomography,CT)的自适应统计迭代重建(adaptive statistical iterative reconstruction,ASIR)。将数据传至AW4.4工作站进行后处理,对患者接受的辐射剂量进行评估,并将所获得的图像质量进行主观评价,探讨MM患者的影像学表现。对比传统X线检查进行统计、分析,比较其灵敏度。并完善患者MM患者骨髓穿刺活检,血清蛋白电泳,免疫固定电泳,DNA荧光原位杂交(Fluorescence in situ hybridization,FISH)结果(显示染色体异常)等检查结果,分析病灶个数与骨髓单克隆浆细胞比例相关性、影像学表现与分期、分型以及基因异常的关系。结果:收集的41例患者中,一般资料符合正态分布。有效辐射剂量为4.75mSv,较传统全身CT降低约81%。WBLDCT较传统X线能发现更多的病灶,41例MM患者中,接受不同部位X线检查者28例,X线阳性者16例,灵敏度为57%,共检出病灶76处,CT阳性者35例,灵敏度为85.4%,检出病灶共240处。41例患者主要表现为骨质破坏,共35例,病变主要累及中轴骨,以累及椎体最为常见,并可出现椎体压缩性骨折。病灶个数与骨髓单克隆浆细胞比例呈不具备相关性(p0.05)。溶骨性阳性患者具有较高的DS分期(p0.01)及ISS分期(p0.05)。骨折阴性者IGH基因异常发生率高。结论:WBLDCT扫描技术在MM的临床应用中具有一定的价值:1.MM患者应用WBLDCT扫描,采用低管电流,并结合宝石CT结合其特有的ASIR技术,能够在保证图像质量的情况下有效降低患者的辐射剂量,为MM患者提供骨质、周围软组织及髓外病变的诊断。2.WBLDCT扫描成像时间快且操作方便,较X线能更好的观察骨质,评估骨折风险,WBLDCT有望替代传统X线,成为MM的首诊影像学诊断。3.WBLDCT扫描与临床分期即患者病情的严重程度相关,能对初诊患者病情恶性程度有一定的预判。
[Abstract]:Objective: to evaluate the clinical value of low dose CT scanning in the diagnosis of multiple myeloma (MM) and to evaluate the severity and prognosis of MM. Methods: 41 cases of MM diagnosed in our hospital from December 2015 to February 2017 were collected. All the patients were scanned by whole body low-dose computerized tomographygraphy (WBLDCT). The voltage of the tube was 140 KV and the current of the tube was 50 Ma. The adaptive statistical iterative reconstruction is reconstructed by using the adaptive statistical iteration of computerized tomographyCTs of gemstone computed tomography (CTS). The data were transferred to the AW4.4 workstation for post-processing to evaluate the radiation dose received by the patients, and the image quality was evaluated subjectively, and the imaging findings of the patients with MM were discussed. Compared with the traditional X-ray examination to carry on the statistics, the analysis, the comparison its sensitivity. The results of bone marrow biopsy, serum protein electrophoresis, immunofixation electrophoresis and fluorescence in situ hybridization in situ (chromosome abnormality) of MM patients were improved, and the correlation between the number of lesions and the proportion of monoclonal plasma cells in bone marrow was analyzed. Imaging findings were associated with staging, typing and genetic abnormalities. Results: the general data of 41 patients were in accordance with normal distribution. The effective radiation dose was 4.75mSv.Compared with the conventional whole body CT, about 81%.WBLDCT could find more lesions in 41 MM patients. Of the 41 patients with MM, 28 patients underwent X-ray examination at different sites and 16 patients had positive X-ray examination. The sensitivity was 57. The sensitivity was 85.4% and the sensitivity was 85.4% in 35 cases with 76 lesions. The main manifestations of the lesions were bone destruction, 35 cases. The lesions mainly involved the axial bone, and the vertebral body was the most common. Vertebral compression fracture may occur. There was no correlation between the number of lesions and the ratio of bone marrow monoclonal plasma cells. The patients with osteolytic positive had higher DS staging (P 0.01) and ISS stage (P 0.05). The incidence of abnormal IGH gene was high in patients with negative fracture. Conclusion: 1. WBLDCT scan, low tube current, combined with gemstone CT combined with its unique ASIR technique, is valuable in the clinical application of MM. It can effectively reduce the radiation dose under the condition of guaranteeing image quality, and provide the diagnosis of bone, surrounding soft tissue and extramedullary lesions for MM patients. 2. WBLDCT scan imaging time is fast and easy to operate, and it can better observe bone than X-ray. Evaluation of fracture risk WBLDCT is expected to replace traditional X-ray as the first imaging diagnosis of MM. 3. WBLDCT scan is related to the severity of clinical stage, which can predict the malignancy of newly diagnosed patients.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R733.3;R730.44

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