Görsel kalitatif DW görüntüleme, ADC kantifikasyonu ve Ki-67 proliferasyon indeksinin referans

Yıl 2018, Cilt: 31 Sayı: 2, 68 - 75, 06.04.2018

Baran Yilmaz Süleyman Sener Hasanaov Teyyub Akın Akakın Özlem Yapıcıer Mustafa Kemal Demir

https://doi.org/10.5472/marumj.413158

Öz

Amaç:  Bu çalışmada amacımız, intrakranyal
meningiomların derecelendirmesinde görsel kalitatif DW görüntüleme, ADC
kantifikasyonu ve Ki-67 proliferasyon indeksinin referans standart
histopatoloji ile karşılaştırıldığında etkinliğini araştırmaktır.

Gereç ve
Yöntem:  Patolojisi meningiom olarak
rapor edilmiş toplam 35 hastamızın, konvansiyonel MR görüntülemeleri,
kontrastlı MR görüntülemeleri, DW görüntülemeleri ve ADC haritaları
arşivimizden elde edilmiştir.

Bulgular:
Sekiz hastada (23%) atipik (5 kadın ve 3 erkek; ortalama yaş: 57.1±15.8 yıl);
27 hastada ise (77%) düşük dereceli tipik meningiom (19 kadın, 8 erkek;
ortalama yaş: 54.3±14.0 yıl) vardı. Hem (59%) en sık histolojik alttip
meningotelyal tip idi. Ki-67 proliferasyon indeksi, düşük dereceli ve atipik
meningiomlarda sırasıyla 2.31±1.44% (aralık: 1-5) and 7.37 ± 2.72% (aralık:
3-10) olarak saptandı. Görsel kalitatif değerlendirmede, difüzyon kısıtlanması
atipi meningiomlarda daha belirgindi (p<0.05). Kantitatif değerlendirmede,
ADC değerlerinde heriki grup arasında anlamlı fark saptanmadı (p=0.471).

Sonuç :
Görsel kalitatif DW görüntüleme değerlendirmesinin, atipi ve cerrahi tedavi
uygulanmış meningiom hastalarında tekrarlama riskinin tahmininde yardımcı
olabileceğini önermekteyiz.

Anahtar Kelimeler

difüzyon ağırlıklı görüntüleme, meningiom, cerrahi, histopatoloji

Visual qualitative evaluation of diffusion-weighted imaging, apparent diffusion coefficient quantification and Ki-67 proliferation index for predicting atypia in surgical meningiomas

Öz

Object. The goal in this study was to investigate the
efficiency of qualitative evaluation using DW imaging, ADC quantification, and Ki-67 proliferation labeling index in grading
intracranial meningiomas compared to our reference standard histopathology.

Methods.
From our database, we enrolled 35 consecutive patients
with pathologic report of a meningioma, conventional
MR imaging, contrast-enhanced MR imaging, DW imaging and ADC maps.

Results.
Eight patients (23%) had atypical
meningioma (5 women and 3 men; mean age: 57.1±15.8
years); 27 (77%) had low-grade-typical (19 women, 8 men; mean age: 54.3±14.0 years). The most frequent histological subtype
was the meningothelial type in both low-grade (37%) and atypical meningiomas
(59%). The mean Ki-67 proliferation index for low-grade and atypical
meningiomas were 2.31±1.44% (range: 1-5) and 7.37 ±
2.72% (range: 3-10), respectively. Meningiomas
with Ki-67 proliferation index higher than 4% (except one) were atypical
(p<0.001). In visual qualitative evaluation;
diffusion restriction was significantly
more common in atypical meningiomas (p<0.05). In
quantitative evaluation, benign and atypical tumor
groups had no significant difference in mean ADC values (p=0.471).

Conclusion.
We suggest that visual qualitative
evaluation of DW imaging may be helpful to predict atypia and the risk of
recurrence in patients with surgically treated meningiomas.

Anahtar Kelimeler

diffusion weighted imaging, meningioma, surgery, histopathology

Kaynakça

• Commins DL, Atkinson RD, Burnett ME. Review of meningioma histopathology. Neurosurg Focus 2007;23:E3.
• Fatima Z, Motosugi U, Hori M, et al. Age-related white matter changes in high b-value q-space diffusion-weighted imaging. Neuroradiology 2013;55:253-259.
• Fatima Z, Motosugi U, Waqar AB, et al. Associations among q-space MRI, diffusion-weighted MRI and histopathological parameters in meningiomas. Eur Radiol 2013;23:2258-2263.
• Filippi CG, Edgar MA, Ulug AM, Prowda JC, Heier LA, Zimmerman RD. Appearance of meningiomas on diffusion-weighted images: correlating diffusion constants with histopathologic findings. AJNR Am J Neuroradiol 2001;22:65-72.
• Hakyemez B, Yildirim N, Gokalp G, Erdogan C, Parlak M. The contribution of diffusion-weighted MR imaging to distinguishing typical from atypical meningiomas. Neuroradiology 2006;48:513-520.
• Hsu CC, Pai CY, Kao HW, Hsueh CJ, Hsu WL, Lo CP. Do aggressive imaging features correlate with advanced histopathological grade in meningiomas? J Clin Neurosci 2010;17:584-587.
• Klimas A, Drzazga Z, Kluczewska E, Hartel M. Regional ADC measurements during normal brain aging in the clinical range of b values: a DWI study. Clin Imaging 2013;37:637-644.
• Knopp EA, Cha S, Johnson G, et al. Glial neoplasms: dynamic contrast-enhanced T2*-weighted MR imaging. Radiology 1999;211:791-798.
• Le Bihan D, Breton E, Lallemand D, Aubin ML, Vignaud J, Laval-Jeantet M: Separation of diffusion and perfusion in intravoxel incoherent motion MR imaging. Radiology 168:497-505, 1988
• Ma C, Xu F, Xiao YD, Paudel R, Sun Y, Xiao EH. Magnetic resonance imaging of intracranial hemangiopericytoma and correlation with pathological findings. Oncol Lett 2014;8(5):2140-2144.
• Mahmood A, Caccamo DV, Tomecek FJ, Malik GM. Atypical and malignant meningiomas: a clinicopathological review. Neurosurgery 1993;33:955-963.
• Maier H, Ofner D, Hittmair A, Kitz K, Budka H. Classic, atypical, and anaplastic meningioma: three histopathological subtypes of clinical relevance. J Neurosurg 1992; 77:616-623.
• Nagar VA, Ye JR, Ng WH, et al. Diffusion-weighted MR imaging: diagnosing atypical or malignant meningiomas and detecting tumor dedifferentiation. AJNR Am J Neuroradiol 2008;29:1147-1152.
• Palma L, Celli P, Franco C, Cervoni L, Cantore G. Long-term prognosis for atypical and malignant meningiomas: a study of 71 surgical cases. J Neurosurg 1997;86:793-800.
• Park HJ, Kang HC, Kim IH, et al. The role of adjuvant radiotherapy in atypical meningioma. J Neurooncol 2013;115:241-247.
• Pavelin S, Becic K, Forempoher G, et al. Expression of Ki-67 and p53 in meningiomas. Neoplasma 2013;60:480-485.
• Perry A, Louis DN, Scheithauer BW. Meningiomas, in Louis DN, Ohgaki H, Wiestler OD (eds). WHO Classification of tumors of the central nervous system. Lyon, France: IARC Press, 2007, pp 164-172.
• Perry A, Scheithauer BW, Stafford SL, Lohse CM, Wollan PC. "Malignancy" in meningiomas: a clinicopathologic study of 116 patients, with grading implications. Cancer 1999;85:2046-2056.
• Riemenschneider MJ, Perry A, Reifenberger G. Histological classification and molecular genetics of meningiomas. Lancet Neurol 2006;5:1045-1054.
• Santelli L, Ramondo G, Della Puppa A, et al. Diffusion-weighted imaging does not predict histological grading in meningiomas. Acta Neurochir (Wien) 2010;152:1315-1319; discussion 1319.
• Sanverdi SE, Ozgen B, Oguz KK, et al. Is diffusion-weighted imaging useful in grading and differentiating histopathological subtypes of meningiomas? Eur J Radiol 2012;81:2389-2395.
• Sasaki M, Yamada K, Watanabe Y, et al. Variability in absolute apparent diffusion coefficient values across different platforms may be substantial: a multivendor, multi-institutional comparison study. Radiology 2008;249:624-630.