| Objective: This study is a comparative analysis of magnetic resonance imaging(MRI)and the cells morphological and pathological examination of bone marrow in leukemia patients.It aims to discuss the relationship among MRI findings of bone marrow,its morphology and pathology to evaluate the clinical value of bone marrow MRI in the diagnosis,evaluation and monitoring of curative effect of leukemia.Materials and methods: Twelve patients with untreated leukemia who were admitted in the Department of Hematology and Oncology of the First Affiliated Hospital of Dali University,from December 01,2017 to November 30,2018,were selected as the observation group.Twelve healthy people who came to the hospital for physical examination,matched with age and sex of the subjects in the observation group,were taken as control group.At the same time,three cases of untreated multiple myeloma and three cases of lymphoma were studied.All subjects were examined by MRI in sagittal and coronal positions of lumbar spine and articulation coxa,including routine sequence(T1WI,T2 WI,FS-T2WI)and water-fat separation sequence(WFOP),who were measured bone marrow fat fraction in the upper femur.The MRI findings of bone marrow were qualitatively and quantitatively analyzed and then compared with the results of bone marrow cell morphology and pathology in leukemia patients.Result: 1.Among 12 patients of leukemia,10 were diagnosed with acute leukemia and 2 patients had chronic leukemia.Among them,there were 6 females and 6 males.The youngest age of the patient was 18 years old,the oldest age was 72 years old,and the median age was 50.5 years old.(1)Morphological examination of bone marrow cells in 10 patients with acute leukemia showed that 7 patients were diagnosed with acute myeloid leukemia and 3 patients with acute lymphoblastic leukemia.Bone marrow proliferation was extremely active in 5 patients,obviously active in 3 patients and 2 active in 2 patients.The content of primitive + immature cells ranged from 26% to 93%.(2)One of 2 patients with chronic leukemia had chronic lymphoblastic leukemia,with markedly active bone marrow hyperplasia.Mature lymphocyte was found in 85% of the bone marrow smears.The other one was chronic myelogenous leukemia with extremely active bone marrow hyperplasia.The results of bone marrow smears showed that the mature granulocyte accounted for 83%.(3)The results of bone marrow pathology of 12 patients in the observation group showed that there were 7 cases of acute myeloid leukemia,3 cases of acute lymphoblastic leukemia,1 case of chronic B-lymphoblastic leukemia and 1 case of chronic myeloid leukemia,which were completely consistent with the results of bone marrow cell morphology.2.12 cases of leukemia showed diffuse changes in lumbar spine and upper femoral bone marrow on MRI.(1)The signal diffusivity and homogeneity of lumbar vertebral bone marrow on T1 WI were decreased,while the signal diffusivity and homogeneity on T2 WI and FS-T2 WI were increased.(2)The upper femoral bone marrow showed diffuse,homogeneous or heterogeneous signal reduction on T1 WI,and diffuse,homogeneous or heterogeneous signal enhancement on T2 WI and FS-T2 WI.(3)There was no difference in the change trend of bone marrow MR signal intensity between 10 patients with acute leukemia and 2 patients with chronic leukemia and between lumbar spine and femur.(4)Bone marrow signals of lumbar spine and upper femur in 2 patients with acute myeloid leukemia in remission phase were significantly improved after treatment.In T1 WI,the signal was significantly increased,and in T2 WI and FS-T2 WI,the signal was decreased.(5)The bone marrow MR findings of leukemia,multiple myeloma and lymphoma patients were significantly different from those of normal controls.The three hematological malignant tumors had similar bone marrow MR findings: the signal on TIWI was decreased,and the signal on T2 WI and FS-WIT2 was increased.3.The results of bone marrow cell morphology and bone marrow pathology were identical in 12 cases of leukemia.The positive rate of bone marrow lesions was consistent with the two methods of bone marrow examination.There was no significant difference in the type of signal changes(homogeneity and heterogeneity)of femoral bone marrow in patients with leukemia with different degree of bone marrow hyperplasia(P > 0.05).There was no significant difference the type of bone marrow MRI changes(homogeneity,heterogeneity)in acute leukemia patients with different content of bone marrow original and immature cells(P > 0.05).4.FF values of upper femoral bone marrow in leukemia observation group and normal control group were(28.990±21.150)% and(93.437±2.805)% respectively.There was a significant difference in FF value of femoral bone marrow between the two groups(P < 0.001).The results showed that FF value of femoral bone marrow in the newly diagnosed and untreated leukemia observation group was significantly lower than that in the normal control group.The FF values of bone marrow lesion area and non-lesion area in leukemia patients with non-homogeneous change of bone marrow MR signal in the upper femur were(38.500±21.409)% and(92.575±3.620)%,respectively,with significant difference(P < 0.05).There was a highly negative correlation between the content of primitive and immature cells in bone marrow and the FF value of upper femoral bone marrow in acute leukemia patients(r=-0.807,P < 0.05).The higher the content of primitive and immature cells in bone marrow,the lower the FF value of upper femoral bone marrow.There was no correlation between the number of white blood cells in peripheral blood and FF value of bone marrow in the upper femur of leukemia patients(P > 0.05).5.The bone marrow MR findings of leukemia,multiple myeloma and lymphoma patients were significantly different from the normal controls.The bone marrow MR findings of the three hematological malignant tumors were similar: the signal on TIWI was decreased,and the signal on T2 WI and FS-WIT2 was increased.The changes of bone marrow MRI in patients with leukemia are not specific.In three groups of patients with hematological malignancies,there was no significant difference between bone marrow biopsy and MRI in the positive detection rate of bone marrow pathology(P = 0.500,> 0.05).The Kappa coefficient was 0.640 by consistency test,that is,the results of the two methods were highly consistent(P=0.004,< 0.05).The FF values of the upper femoral bone marrow of patients with multiple myeloma and lymphoma were(60.407±28.884)% and(61.247±28.866)% respectively,which were significantly lower than those of the control group,but there was no significant difference between the two groups.Conclusion: This study showed that the MR imaging of lumbar spine and upper femoral bone marrow in patients with newly untreated leukemia showed abnormalities: T1 WI showed diffuse signal reduction,T2 WI and FS-T2 WI increased diffuse signal;FF of upper femoral bone marrow in leukemia patients quantitatively measured by water-lipid separation technology was significantly lower than that in normal controls,and had a highly negative correlation with the content of leukemia cells in patients’ bone marrow.The results of bone marrow MRI are consistent with those of bone marrow morphology and pathology,which can more accurately reflect the pathological changes of bone marrow.It is concluded that bone marrow MRI examination is of great clinical significance in the diagnosis,evaluation and monitoring of curative effect of leukemia. |
PDF Full Text Request