本文選題：多發(fā)性骨髓瘤 + 低劑量��； 參考：《山西醫(yī)科大學》2017年碩士論文

【摘要】：目的:探討全身低劑量CT掃描在多發(fā)性骨髓瘤(multiple myeloma,MM)臨床應用中的價值,為MM的診斷提供一種新思路,評估MM的病情嚴重程度及預后。方法:連續(xù)收集2015年12月至2017年2月首診于我院經確診為MM患者41例�；颊呔M行全身低劑量計算機斷層掃描(whole-body low-dose computerized tomography,WBLDCT)掃描,掃描管電壓為140KV,管電流50mA。并使用寶石計算機斷層掃描(computerized tomography,CT)的自適應統(tǒng)計迭代重建(adaptive statistical iterative reconstruction,ASIR)。將數(shù)據(jù)傳至AW4.4工作站進行后處理,對患者接受的輻射劑量進行評估,并將所獲得的圖像質量進行主觀評價,探討MM患者的影像學表現(xiàn)。對比傳統(tǒng)X線檢查進行統(tǒng)計、分析,比較其靈敏度。并完善患者MM患者骨髓穿刺活檢,血清蛋白電泳,免疫固定電泳,DNA熒光原位雜交(Fluorescence in situ hybridization,FISH)結果(顯示染色體異常)等檢查結果,分析病灶個數(shù)與骨髓單克隆漿細胞比例相關性、影像學表現(xiàn)與分期、分型以及基因異常的關系。結果:收集的41例患者中,一般資料符合正態(tài)分布。有效輻射劑量為4.75mSv,較傳統(tǒng)全身CT降低約81%。WBLDCT較傳統(tǒng)X線能發(fā)現(xiàn)更多的病灶,41例MM患者中,接受不同部位X線檢查者28例,X線陽性者16例,靈敏度為57%,共檢出病灶76處,CT陽性者35例,靈敏度為85.4%,檢出病灶共240處。41例患者主要表現(xiàn)為骨質破壞,共35例,病變主要累及中軸骨,以累及椎體最為常見,并可出現(xiàn)椎體壓縮性骨折。病灶個數(shù)與骨髓單克隆漿細胞比例呈不具備相關性(p0.05)。溶骨性陽性患者具有較高的DS分期(p0.01)及ISS分期(p0.05)。骨折陰性者IGH基因異常發(fā)生率高。結論:WBLDCT掃描技術在MM的臨床應用中具有一定的價值:1.MM患者應用WBLDCT掃描,采用低管電流,并結合寶石CT結合其特有的ASIR技術,能夠在保證圖像質量的情況下有效降低患者的輻射劑量,為MM患者提供骨質、周圍軟組織及髓外病變的診斷。2.WBLDCT掃描成像時間快且操作方便,較X線能更好的觀察骨質,評估骨折風險,WBLDCT有望替代傳統(tǒng)X線,成為MM的首診影像學診斷。3.WBLDCT掃描與臨床分期即患者病情的嚴重程度相關,能對初診患者病情惡性程度有一定的預判。
[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.
【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R733.3;R730.44

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