骨髓瘤的临床与影像学诊断(Clinical and imaging diagnosis of myeloma)
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骨髓瘤的临床与影像学诊断（Clinical and imaging diagnosis of
myeloma）
多发性骨髓瘤 (multiple myetoma, 为一复杂而特殊的恶性肿瘤 mm或骨髓瘤)
.据统计, 其发病率 (0.2～0.4 / 10万人口) 较其它全部恶性肿瘤的总和还多, 其
死亡率也较其它恶性肿瘤高3～10倍, 而临床诊出率则仅为其发病率的0.5% 左右.
误诊率高达54% ～100%.因此, 研究骨髓瘤的病因、病理、临床表现及影像学特征
减少误, 对提高此病的正确诊断率, 诊率均具有重要意义 (漏).
1 骨髓瘤的病因、病理及分类
骨髓瘤是浆细胞异常增生的恶性肿瘤, 属浆细胞病的一种.它通常分为孤立性
骨髓瘤、多发性骨髓瘤、髓外骨髓瘤和浆细胞白血病四种类型.目前多数学者按病
也可按瘤细胞的病理分化程度 灶数目将其分为单发性骨髓瘤和多发性骨髓瘤两种.
分为高分化型 (小细胞型) 和低分化型 (大细胞型 根据蛋白电泳特点 (按m蛋).
白性质不同) 分为igg (50～60%) 、iga 7% ～42%) 、igd、 ige等型.
骨髓瘤的病因目前尚不明确, 一般认为c - myc基因重组、淋巴因子中的白介素
(b) 等因素与其发病有关 病理上, 病变始于红骨髓, 呈局限性或弥漫性大.
量浆细胞浸润, 瘤细胞聚集成堆, ～90 引起某处或多处的 可占骨髓内细胞的5%%
骨质疏松或骨质破坏, 其中以脊柱、肋骨、颅骨最多见, 并且尸检证实约70% 的骨
髓瘤有髓外浸润, 以肝、脾、肾和淋巴结最多见, 瘤细胞聚集于脏器与组织间形成
实质性肿块.
瘤组织在骨髓腔内形成灰红色结节 骨髓瘤引起骨质疏松或骨质破坏的机理是.
随.
着瘤细胞群体的不断增殖, 瘤细胞激活破骨细胞, 使其数量增多,
活性增加, 促进
骨质溶解吸收 瘤组织广泛增生可引起骨质疏松.由于骨质溶解吸收加快, 肾小球.
滤过率减低, 使得血钙增高, 骨质脱钙, 从而加重了骨质疏松的程度.
2 临床表现及实验室检查
骨髓瘤好发于50～60岁的男性, 以颅骨、脊柱、肋骨、骨盆等部位最易受累.
骨痛常为早期和主要症状, 并随病情发展而加重.以腰骶部和胸背部疼痛最为常见
可出现病理性骨折和软组织肿块.此外, 临床上可出现感染、贫血、出血倾向、.
泌尿系症状, 肝、脾、淋巴结肿大等.
实验室检查可出现多种异常.贫血、全血细胞减少、血沉增快、血液中可见大
则称为浆细胞性白血病.骨髓涂片 量骨髓瘤细胞.若骨髓瘤细胞超过2000个 / mm3.
可见浆细胞异常增生, 占有核细胞的15% 以上, 并伴有质的改变.血液生化检查.
血清蛋白电泳r球蛋 显示血清球蛋白增高而白蛋白降低或正常、出现a / g比例倒置.
白升高和出现m蛋白; 血清钙增高; 90% 以上患者有蛋白尿 患者尿液中出 ～60% 40%
现本 - 周 (bence 氏蛋白 jones).
3 影像学检查及表现
3.1 x线检查.
在ct及mri出现之前, x线检查是骨髓瘤的主要影像学检查手段.因此, 有关骨
髓瘤的早期x线表现、特殊表现及典型表现、x线分型及鉴别诊断, 许多作者均作了
广泛而深入的探讨, 积累了丰富的经验.
主要x线表现及分型 骨髓瘤的主要x线表现有骨质疏松、骨质破坏、骨 3.1.1:
质硬化和软组织肿块.根据上述表现不同, x线上一般分为5型 ① 骨质正 (或6型).
Normal type: there was no obvious X ray manifestation of bone.
Osteoporosis: Universal osteoporosis is the main X-ray
manifestation
A double concave deformation, vertebral body. Destruction of
bone (without soft tissue mass): the bone is destroyed by insect
like bone
The ribs, pelvis was punched out), change (skull) or large
osteolytic destruction (like limbs long Guan Gu). Bone mass
Destruction with soft tissue mass. Bone sclerosis type:
characterized by simple, diffuse, elevated density, or during
bone destruction
Sign of bone sclerosis. The single hair: the characteristics
of the lesions occur in long bone metaphysis, showing cystic
or
Multiple bone destruction can be accompanied by bony mass or
pathological fracture, and periosteal reaction is rare.
3.1.2 early X-ray findings and rare manifestations: the upper
margin of the ribs, bone cortex or internal and external
limitations of the skull plate thinning
Uneven thickness and corrugated mark were the early X-ray
findings of myeloma. Its rare X-ray findings are irregular
Fuzzy bonedestruction radial spicules occur around the soft
tissue mass in the bone surrounding the bone hard failure zone
Of.
3.2 CT inspection and performance:
The CT scan shows its advantages with unique high-density
resolution and clear cross sectional images. It can clear
It clearly shows the internal structure, soft tissue,
pathological changes, extent and the invasion of the internal
and external medullary cavity
Such degree. It is reported that CT shows the extent of
intramedullary infiltration of bone tumors compared with the
pathological results, the accuracy rate is 91.3
% to 99.1%. In myeloma cases, CT is especially valuable in
patients who have bone pain and who have negative X-ray findings
or whose lesions are unclear
Because bone destruction occurs, later cortical bone on the
plain film can obscure the manifestation of intramedullary
lesions. The chief of myeloma
CT is characterized by osteolytic destruction of bone,
irregular edges, blurring, destruction of cortical bone, and
sometimes periosteal proliferation
Local soft tissue mass. In addition, adjusting the proper
window width and window position during the CT scan is helpful
for the detection of minor diseases
Variable.
3.3 MRI inspection and performance:
Because of the advantages of MRI imaging, MRI has become the
best imaging method for the evaluation of bone marrow diseases
. It is able to observe the whole body bone marrow changes
without trauma and overcome some limitations of bone marrow
aspiration and / or biopsy
