Meme lezyonlarında ayırıcı tanıda kantitatif difüzyon ağırlıklı manyetik rezonans görüntüleme
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Dosyalar
Tarih
2012
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Trakya Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Meme manyetik rezonans görüntülemede değerlendirme yapabilmek için lezyonun morfolojik özelliği ve kontrast tutma dinamiği kullanılmaktadır. Bu iki parametre kullanıldığında meme manyetik rezonans görüntülemenin duyarlılığı yüksek olmakla birlikte özgüllüğü düşük oranlarda bildirilmektedir. Çalışmamızda rutin meme görüntülemesi yapılan olgularda rutin incelemeye ek olarak kontrast madde gerektirmeyen difüzyon ağırlıklı görüntüleme yapılarak lezyonlarda ayırıcı tanıya olan katkısını değerlendirmeyi amaçladık. Nisan 2010 Temmuz 2011 tarihleri arasında, meme manyetik rezonans incelemesi için ünitemize başvuran ve rutin meme inceleme yanında difüzyon ağırlıklı görüntüleme yapılan 101 erişkin kadında toplam 109 lezyon çalışma kapsamına alındı. Tüm olgularda histopatolojik tanıya gidildi. Difüzyon ağırlıklı görüntüler 30 sn.'de elde olundu. Manyetik rezonans cihazının konsolunda, özel yazılım aracılığıyla görünür difüzyon katsayısı otomatik olarak ölçülerek harita görüntüleri hazırlandı. Değerlendirmede anormal kontrast tutulumu gösteren solid lezyonlar ve kistlerin konvansiyonel sekanslardaki bulguları yanı sıra difüzyon ağırlıklı incelemedeki görsel analizi ve görünür difüzyon katsayı haritasından ölçülen değerleri not edildi. Konvansiyonel meme manyetik rezonans incelemede saptanan lezyonların difüzyon kısıtlanması varlığı araştırıldı. Kantitatif değerlendirme amacı ile görünür difüzyon katsayı haritalarında ölçüm dairesi kullanarak ölçüm yapıldı. Ölçümler kontrastlanan tümör dokusundan elde edildi. Tümörün nekrotik kısmı ve normal doku ölçüm dairesi dışında bırakıldı. Memenin malign lezyonlarının görünür difüzyon katsayısı benign lezyonlarından anlamlı derecede düşük olarak bulunmuştur. Benign lezyonlarda görünür difüzyon katsayısı ortalama 1.6x10-3mm2/sn, malign lezyonlarda ise görünür difüzyon katsayısı ortalama 1.20x10-3mm2/sn olarak saptanmıştır. Tüm lezyonların görünür difüzyon katsayısı ?Receiver Operating Characteric analizi ile 1.12x10-3mm2/sn sınır olarak alındığında %82.1 sensitivite ve %69.8 spesifite ile benign malign ayrımı yapabilmektedir (p<0.001). Difüzyon ağırlıklı görüntüleme tek başına ayırıcı tanı yapamamasına rağmen, konvansiyonel meme manyetik rezonans incelemeye tamamlayıcı olarak kullanılabilir.
Abstract
To evaluate the breast magnetic resonance imaging morphological features of the lesion and the dynamics of contrast enhancement are used. Although, the sensitivity of breast magnetic resonance imaging is high, low rates of the specificity have been reported when these two parameters are used. In this study, we aimed to evaluate the contribution of the diffusion-weighted imaging that does not require contrast agent on differential diagnosis of lesions in addition to the routine examination of breast magnetic resonance imaging. Between April 2010 - July 2011, 109 lesions from 101 adult women, who applied to our unit for breast magnetic resonance investigation and were examined by routine breast examination as well as diffusion-weighted imaging, were included in the study. Histopathological diagnoses were made in all cases. Diffusion-weighted images were obtained in 30 sec. At the console of magnetic resonance imaging device, the map images were automatically created by measuring the Apperent Diffusion Coefficient values through custom software. In the evaluation process, in addition to abnormal contrast enhancement displaying solid lesions and findings in the conventional sequences of cysts, visual analysis of diffusion-weighted examination and measured values of apperent diffusion coefficient map were noted. In detected lesions with conventional breast magnetic resonance imaging examination, the presences of restricted diffusion were investigated. With the aim of quantitative evaluation, measurement circle was used to measure on the Apperent Diffusion Coefficient maps. The measurements were obtained from contrasted tumor tissue. Necrotic portion of the tumor and normal tissue were excluded from the measurement circle. Apperent Diffusion Coefficient value of breast malignant lesions was found to be significantly lower than of the benign lesions. The mean Apperent Diffusion Coefficient value has been determined as 1.6x10-3mm2/sn, for benign lesions and as 1.20x10-3mm2/sn for malignant lesions. If the limit was defined as 1.12x10-3mm2/sn with Receiver Operating Characteric analysis for Apperent Diffusion Coefficient values of all lesions, the distinction between benign and malignant can be made with 82.1% sensitivity and 69.8% specificity (p <0.001). Although diffusion-weighted imaging can not make differential diagnosis alone, it can be used to complement conventional breast magnetic resonance investigation.
Abstract
To evaluate the breast magnetic resonance imaging morphological features of the lesion and the dynamics of contrast enhancement are used. Although, the sensitivity of breast magnetic resonance imaging is high, low rates of the specificity have been reported when these two parameters are used. In this study, we aimed to evaluate the contribution of the diffusion-weighted imaging that does not require contrast agent on differential diagnosis of lesions in addition to the routine examination of breast magnetic resonance imaging. Between April 2010 - July 2011, 109 lesions from 101 adult women, who applied to our unit for breast magnetic resonance investigation and were examined by routine breast examination as well as diffusion-weighted imaging, were included in the study. Histopathological diagnoses were made in all cases. Diffusion-weighted images were obtained in 30 sec. At the console of magnetic resonance imaging device, the map images were automatically created by measuring the Apperent Diffusion Coefficient values through custom software. In the evaluation process, in addition to abnormal contrast enhancement displaying solid lesions and findings in the conventional sequences of cysts, visual analysis of diffusion-weighted examination and measured values of apperent diffusion coefficient map were noted. In detected lesions with conventional breast magnetic resonance imaging examination, the presences of restricted diffusion were investigated. With the aim of quantitative evaluation, measurement circle was used to measure on the Apperent Diffusion Coefficient maps. The measurements were obtained from contrasted tumor tissue. Necrotic portion of the tumor and normal tissue were excluded from the measurement circle. Apperent Diffusion Coefficient value of breast malignant lesions was found to be significantly lower than of the benign lesions. The mean Apperent Diffusion Coefficient value has been determined as 1.6x10-3mm2/sn, for benign lesions and as 1.20x10-3mm2/sn for malignant lesions. If the limit was defined as 1.12x10-3mm2/sn with Receiver Operating Characteric analysis for Apperent Diffusion Coefficient values of all lesions, the distinction between benign and malignant can be made with 82.1% sensitivity and 69.8% specificity (p <0.001). Although diffusion-weighted imaging can not make differential diagnosis alone, it can be used to complement conventional breast magnetic resonance investigation.
Açıklama
Tıpta Uzmanlık Tezi
Anahtar Kelimeler
Meme Kanseri, Görünür Difüzyon Katsayısı, Difüzyon Manyetik Rezonans Görüntüleme, Breast Cancer, Apperent Diffusion Coefficient, Diffusion Magnetic Resonance Imaging
