| BackgroundLeukemia is a kind of disease caused by malignant cloning caused by abnormal hematopoietic mechanism of hematopoietic stem cells.Malignant leukemia cells proliferate and differentiate abnormally in bone marrow and other hematopoietic tissues,infiltrate other non-hematopoietic tissues and organs,and inhibit the normal hematopoietic function of the body.Clinical manifestations include anemia,hemorrhage,fever caused by infection,enlargement of liver,spleen and lymph nodes,accompanied by bone pain and other symptoms.According to statistics,the incidenceof leukemia ranks sixth in the incidence of tumors in all regions of China,which seriously threatens human life.There are many kinds of leukemia,which can be divided into different types according to their classification.First,according to the degree of differentiation and maturation of leukemia cells,acute leukemia can be divided irnto acute and chronic leukemia.Then acute leukemia can be divided into acute lymphocytic leukemia(ALL)and acute non-lymphocytic leukemia(ANLL)according to the series of involved cells.Acute lymphoblastic leukemia can be divided into three subtypes:Ll,L2,L3.And acute non-lymphoblastic leukemia also has eight subtypes:M0?7.Chronic leukemia can also be divided into four types:chronic myelogenous leukemia(CML),chronic lymphocytic leukemia(CLL),hairy cell leukemia(HCL)and prolymphocytic leukemia(PLL),which the former two are the most common.Therefore,different subtypes of leukemia have different diagnostic criteria,treatment methods and effects are also very different.With the development of medicine,MICM typing composed of cell morphology,immunology,cytogenetics and molecular biology will be more accurate in the diagnosis of classification and subtypes.In clinical work,it will gradually replace the traditional mode of diagnosis based only on leukemia cell morphology.At present,the diagnostic and typing standards of MICM used in the world can diagnose leukemia from the molecular biological level such as the pathogenesis and biological characteristics of leukemia,so it has practical value for guiding clinical treatment and prognosis.Of course,although the MICM classification is the diagnostic criteria for leukemia,the diagnosis and the review of each efficacy assessment require a bone marrow biopsy,which causes great pain to the patient,poor reproducibility and bone marrow aspiration can only be evaluated locally from patients with leukemia and it is not enough to assess bone marrow changes from an overall level.Since the 1980s,Cohen and Moore first used MRI(magnetic resonance imaging,MRI)imaging to qualitatively and quantitatively study the bone marrow of children with leukemia,and opened up the exploration of leukemia using non-invasive imaging methods.MRI imaging is non-invasive,easily accepted by patient,and can be used to assess bone marrow changes as a whole,and has been gradually applied in clinical.Leukemia is an abnormal hematopoietic system of bone marrow,which changes from normal red bone marrow to yellow bone marrow to reverse transformation from yellow bone marrow to red bone marrow.This is also the basis for quantitative or qualitative study of bone marrow changes in imaging.In addition to the initial magnetic resonance imaging,radionuclide bone imaging(RNBI)and computed tomography(CT)techniques have emerged.However,in the field of bone marrow imaging,MRI imaging has been the preferred method of examining bone marrow imaging.MRI bone marrow imaging can not only show the changes of normal bone marrow,but also have great practical value in the diagnosis of multiple or localized bone marrow lesions,the classification of hematopoietic malignant diseases and the evaluation of clinical treatment effects.However,its long inspection time,patients are not easy to tolerate,and many factors such as MR contraindications also affect its use to a certain extent,so diagnosing accurately and rapid non-invasive imaging technology is needed.In the past,due to technical limitations,RNBI was rarely used in the examination of blood diseases.With the emergence of Single-Photon Emission Computed Tomography(SPECT),scholars began to explore the diagnostic value of bone marrow imaging in hematological diseases by RNBI,SPECT as a new non-invasive detection method,using radionuclide labeling,can observe the bone marrow activity and lesion distribution in leukemia,but because of its large radiation dose which have potential hazards to leukemia patients that limit their clinical use.Dual-energy CT imaging technology has experienced two eras of single-source CT and dual-source CT.In the single-source dual-energy CT era,due to the slow development of technology,single-source dual-energy CT imaging technology has almost no application in practical clinical work.The development of imaging technology has been greatly limited.In recent years,with the emergence of dual-source dual-energy CT,especially the third-generation dual-source dual-energy CT(DSDECT),the use of CT to observe bone marrow lesions is more sensitive and accurate.DSDECT complete bone marrow imaging with virtual non-calciumtechnique(VNCa).CT bone marrow imaging has shown important clinical value in the evaluation of fracture edema,metastases and multiple myeloma,and showed good consistency with MR findings.But the overall detection time of MR as the gold standard verification mode has not decreased.In addition,for diffuse lesions,CT and MR verification also have significant problems.Therefore,how to establish the normal bone marrow CT value of the normal population,thus providing a reliable verification standard for bone marrow disease is of great significance,but there is still no gold standard for bone marrow in the normal population.Besides,the value of this standard in the evaluation of diffuse lesions needs to be further explored.As far as CT bone marrow imaging is concerned,this method has rarely been reported in the study of hematological diseases.It is limited to the study of multiple myeloma.We suspect that except multiple myeloma,bone marrow changes in leukemia can also be quantitatively detected by DSDECT.Based on this,this study first explores the CT value of healthy adult bone marrow vertebral body to establish a reliable normal standard as a basic reference for studying bone marrow changes in leukemia and even other blood diseases;then explore DSDECT to quantitatively evaluate leukemia bone marrow infiltration and The value of efficacy,which provides another new,non-invasive assessment technique for assessing the efficacy of leukemia,extending the range of imaging studies.Based on this,this study first explores the CT value of healthy adult vertebral bone marrow to establish a reliable normal standard as a basic reference for studying bone marrow changes in leukemia and even other blood diseases and then explore DSDECT evaluate leukemia bone marrow infiltration and the value of efficacy quantitatively,which provides another new and non-invasive assessment technique for assessing the efficacy of leukemia,extending the range of imaging studies.ObjectiveThe quantitative standard values of adult normal thoracic and lumbar in bone marrow imaging were explored by using the third generation DSDECT virtual non-calcium technique,which can be used as a reference for the study of leukemia and other hematological diseases,and quantitatively evaluate its value in the evaluation of leukemia efficacy.MethodsThe study was approved by the Medical Ethics Committee of Qilu Hospital of Shandong University(Coreon No.2017091),and patients all signed informed consent.200 volunteers who came to our hospital for health examination from August to November 2017 were collected and their height,weight,age,sex and body mass index(BMI)were recorded.All the subjects were divided into male and female groups of<45 years old(young group)and>45 years old(middle-aged group),with 50 individuals in each group.The bone marrow CT values(HU)of T3-L5 vertebrae body were measured through the virtual non-calcium technique by DSDECT,and then,according to the approximate degree,above measured CT values of each vertebral body were divided into T3-T5,T6-T9,T10-L1,L2-L5,followed by calculating the mean values.Independent sample t test was used to analyze the relationship between bone marrow CT values and the above-mentioned different indicators,and to explore the regularity of bone marrow imaging with DECT in normal adults.Another 67 cases of leukemia patients were collected from our hospital.100 healthy volunteers were randomly selected to form a control group,which had the same conditions as leukemia patients in age and sex.All patients with leukemia were diagnosed by MICM.Among them,51 cases were acute leukemia and 16 cases were chronic leukemia.In patients with acute leukemia,there are 13 patients with ALL and 38 patients with ANLL(1 case of M2,9 cases of M3,2 cases of M4,21 cases of M5,4 cases of M6,1 cases of M7).In patients with chronic leukemia,9 patients with CML and 7 patients with CLL were included.According to the results of bone marrow puncture and cytomorphological immunophenotype analysis,leukemia patients were divided into different subgroups,including 18 cases of newly diagnosed patients,9 cases of non-remission patients after chemotherapy,13 cases of relapsed patients after chemotherapy,and 27 cases of remission patients after chemotherapy,the newly diagnosed patients,patients with non-remission after chemotherapy and patients with recurrence after chemotherapy were all classified as active leukemia group.All patients with leukemia need to obtain the bone marrow CT values of their T3-L5(spine)vertebrae through the 3rd generation DECT scanning.The healthy control group and different subgroups of leukemia patients are divided into young group and middle-aged group by 45 years old,as well as male group and female group.By analyzing and comparing the differences of bone marrow CT values among different age and sex groups,the diagnosis and treatment value of DECT for leukemia is quantitatively evaluatedResults1.The bone marrow CT values of thoracic and lumbar vertebrae in young group were(-29.00±10.62)HU and(-35.81±12.36)HU,respectively,which were both higher than those in middle-aged group with(-41.67±17.16)HU and(-44.81±14.35)HU,and the differences were significant(t =-6.326,-4.746,all P values<0.01).2.The bone marrow CT values of thoracic and lumbar vertebrae in young female group were significantly higher than those in middle-aged female group[(-27.76±9.55)HU and(-37.56±9.05)HU vs.(-37.80±15.97)HU and(-45.45±14.04)HU],and the differences were significant(t=3.818,3.339,all P values<0.Ol).The bone marrow CT values of thoracic and lumbar vertebrae in young male group were(-30.73112.16)HU and(-33.91±14.64)HU,respectively,which were also significantly higher than those in middle-aged male group with(-46.07±17.42)HU and(-44.68±14.84)HU,and the differences were significant(t = 5.105,3.653,all P values<0.01).The measured bone marrow CT values both in thoracic and lumbar vertebrae were negatively correlated with age(r =-0.463,-0.402,all P values<0.01).3.For thoracic vertebrae,there was no significant difference in bone marrow CT values in both female and male of young groups(P>0.05),but except for that in the middle-aged group(t=2.474,P<0.01);as for lumbar vertebrae,there was no significant difference in CT values of bone marrow in both female and male either in the young or middle-aged groups(all P values>0.05)4.The average bone marrow CT values of T3-T5,T6-T9,T10-Li and L2-L5 in the young group were all higher than those in the middle-aged group,and the differences were statistically significant(all P values<0.01).However,statistical differences were only observed between bone marrow CT values of segments of T6-T9 and T10-L1 vertebrae in the middle-aged group(t=-3.177,-2.326,all P values<0.05)when compared between genders,and other CT values did not approach significant difference(all P values>0.05)5.The average CT dose index volume(CTDIvol)and dose length product(DLP)values were 4.53?18.79(8.73 ± 2.98)mGy and 117.34?1678.42(421.53?230.85)mGy'cm,respectively,and meanwhile the effective radiation dose in this study was(6.35?3.43)mSv.6.The bone marrow CT values in young and middle-aged groups of healthy control volunteers were(-31.45±9.63)HU and(-46.07±13.79)HU;that in young and middle-aged groups of active leukemia patients were(13.89±8.65)HU and(4.30±10.38)HU;that in young and middle-aged groups of remission patients were(-21.49±22.09)HU and(-40.71±17.64)HU.The bone marrow CT values of vertebral in the young group of healthy control volunteers and the young group of remission patients were higher than those in the middle-aged group respectively,the difference were statistically significant(P<0.05),while the CT values of bone marrow in the active group of leukemia had no significant difference between ages(P>0.05);in the young group or the middle-aged group,there was no significant difference in the CT values of bone marrow between the healthy control group and the remission group of leukemia(P>0.05),but no matter in the young group or the middle-aged group,there were significant differences between leukemia active group,healthy control group and remission group in the corresponding age group(P<0.05).7.There was no significant difference in bone marrow CT values between the healthy control group,leukemia activegroup and remission group(P>0.05).8.The bone marrow CT values in newly diagnosed leukemia group was(5.44±19.52)HU,in non-remission group was(-0.48±11.19)HU,and in relapse group was(1.10±10.76)HU.There was no significant difference between the three groups(P>0.05).ConclusionsDSDECT virtual non-calcium technique is a new,simple and non-invasive quantitative evaluation technology.It can accurately reflect the normal and leukemia activities and relieve the changes of spinal vertebral bone marrow in patients.The CT values of thoracic and lumbar vertebral bone marrow measured by dual-energy CT can be used as the standard values of normal vertebral body.It has an important reference value in evaluation of curative effect of leukemia and other hematological diseases.In some cases,it helps clinicians to reduce the number of bone marrow puncture. |
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