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Endometriyal Kanser Evrelemesinde Difüzyon Ağırlıklı Manyetik Rezonans Görüntülemenin Yararı

Year 2020, Volume: 9 Issue: 1, 20 - 27, 08.04.2020

Abstract

AMAÇ: Endometrium kanserinde, difüzyon ağırlıklı manyetik rezonans görüntüleme (MRG)'nin uygulanabilirliği ve değerini belirleyerek preoperatif evre öngörüsüne katkısını araştırmak.
GEREÇ ve YÖNTEMLER: Çalışma grubuna histopatolojik olarak endometrium kanseri tanısı konmuş 26 hasta, kontrol grubuna ise herhangi bir uterin patolojisi olmayan 20 hasta alındı. Tüm hastalara tümör evrelemesi için pelvik MRG uygulandı. Ayrıca, difüzyon ağırlıklı görüntüler, 1.5-T MR kullanılarak B değeri 0, 500 ve 1000 s/mm² olan düzlemsel spin-eko görüntülerle aksiyal planda taranması ile elde edildi. Bu görüntüler bağımsız iş istasyonuna (Leonardo console, software version 2.0) aktarılarak, olguların analizi ve apparent diffusion coefficient (ADC) ölçümleri yapıldı. Çalışma grubunda ADC ölçümleri; tümör dokusunun üç ayrı noktasından sirküler ROI (region of interest) kullanılarak yapıldı. Kontrol grubunda ise ROI, normal servikal doku, endometrium ve myometrium kullanılarak yapıldı. Her bir ADC ölçümü için 3 farklı ROI değerinin ortalaması alındı ve ortalama ADC değerleri birbiriyle karşılaştırıldı.
BULGULAR: Çalışma grubundaki hastaların ortalama yaşı 60.42±7.68, kontrol grubundakilerin ise 58.60±8.11’dir. Ortalama ADC değerleri; çalışma grubunda 0.75±0.16x10¯³ mm²/s, kontrol grubunda ise 1.45±0.10x10¯³ mm²/s olarak bulundu. İki grup arasında ortalama ADC değerleri açısından istatistiksel olarak anlamlı farklılık olduğu tespit edildi(p=0.01). Ancak çalışma grubundaki olguların histolojik grade’i ile ADC değerleri arasında anlamlı bir farklılık saptanmadı(p>0.05).
SONUÇ: Difüzyon MRG’de ölçülen ortalama ADC değerleri; kanserli ve normal endometrium dokusunu ayırt etmek için etkin bir şekilde kullanılabilir, kanserli olguların cerrahi yönetimi ve preoperatif tümör evresini öngörmek için önemli katkılar sunabilir.

References

  • Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics,2014. CA Cancer J Clin 2014; 64(1): 9–29.
  • Rockall AG, Meroni R, Sohaib SA, Reynolds K, Alexander-Sefre F, Shepherd JH, Jacobs I, Reznek RH. Evaluation of endometrial carcinoma on magnetic resonance imaging.Int.J.Gynecol. Cancer. 2007; 17 (1): 188 – 96.
  • Atalay F, Çetinkaya K, Bacınoglu A. Is the 2009 FIGO staging system really valuable for stage I endometrial cancer? Eur J Gynecol Oncol 2013. 34:556-8.
  • Larson DM, Connor GP, Broste SK, Krawisz BR, Johnson KK. Prognostic significance of gross myometrial invasion with endometrial cancer. Obstet Gynecol. 1996; 88 (3): 394 – 8
  • Görker S, Harma M, Harma Mİ. Endometrial Cancer General Perspectives, Epidemiology. Current Obstetrics and Gynecology Reports. 2019: 1-3.
  • Patel S, Liyanage SH, Sadhev A, et al. Imaging of endometrial and cervical cancer. Insights Imaging 2010, 1:309-28.
  • Funda ATALAY, Kadir ÇETİNKAYA. Myometrial Invasion In Endometrial Cancer Patients: Can Magnetic Resonance Imaging Predict The Myometrial Invasion Before Surgery? The Journal of Gynecology - Obstetrics and Neonatology. 2016;13(2): 55-7
  • John L. Currie, Malignant Tumors of the Uterine Corpus in, John D. Thompson, John A. Rock, Te Linde’s Operative Gynecology, Seventh Edition, J.B. Lippincott Company, 1992;1263
  • Koyama T, Tamai K, Togashi K. Sataging of carcinoma of the uterine cervix and endometrium. Eur Radiol, 2007, 17: 2009-19
  • Hricak H, Stern JL, Fisher MR, et al. Endometrial carcinoma staging by MR imaging. Radiology 1987, 162:297-305.
  • Whittaker CS, Coady A, Culver L, Rustin G, Padwick M, Padhani AR. Diffusion weighted MR imaging of female pelvic tumors: a pictorial review. Radiographics. 2009;29(3):759–74. discussion 774-7.
  • Shen SH, Chiou YY, Wang JH, Yen MS, Lee RC, Lai CR, Chang CY. Diffusion-weighted single-shot echo-planar imaging with parallel technique in assessment of endometrial cancer. AJR Am J Roentgenol. 2008; 190:481-88.
  • Wang J, Yu T, Bai R, Sun H, Zhao X, Li Y. The value of the apparent Diffusion Coefficient in differentiating stage 1A endometrial carcinoma from normal endometrium and benign diseases of the endometrium: Initial study at 3-T Mag. Resonance Scanner. J Comput Assist Tomog 2010; 34:332-37.
  • Inada Y, Matsuki M, Nakai G, Tatsugami F, Tanikake M, Narabayashi I, Yamada T, Tsuji M. Body diffusion-weighted MR imaging of uterine endometrial cancer:is it helpful in the detection of cancer in nonenhanced MR imaging? Eur J Radiol 2009; 70:122-27.
  • Lin G, Ng KK, Chang CJ, Wang JJ, Ho KC, Yen TC, Wu TI, Wang CC, Chen YR, Huang YT, Ng SH, Jung SM, Chang TC, Lai CH. Myometrial invasion in endometrial cancer: diagnostic accuracy of diffusion-weighted 3.0-T MR imaging–initial experience. Radiology. 2009; 250(3): 784–92.
  • Rechichi G, Galimberti S, Signorelli M, Perego P, Valsecchi MG, Sironi S. Myometrial invasion in endometrial cancer: diagnostic performance of diffusion-weighted MR imaging at 1.5 T. Eur Radiol 2010;20:754-762.
  • Creasman W.: Revised FIGO staging for carcinoma of the endometrium. Int J Gynaecol Obstet 2009; 105: pp. 109
  • Colagrande S, Pallotta S, Vanzulli A, Napolitano M, Villari N. The diffusion parameter in magnetic resonance: physics, techniques, and semeiotics. La Radiologia Medica. 2005;109 (1–2):1–16.
  • Rechichi G, Galimberti S, Signorelli M, Franzesi CT, Perego P, Valsecchi MG, Sironi S. Endometrial cancer: correlation of apparent diffusion coefficient. with tumor grade, depth of myometrial invasion, and presence of lymph node metastases AJR Am J Roentgenol. 2011;197(1):256–62.
  • Brown H. K, Stoll B. S, Nicosia S. V, et al: Uterine junctional zone: Corelation between histologic findings and MR imaging. Radiology 179:409-413,1991
  • Deng L, Wang QP, Yan R, Duan XY, Bai L, Yu N, Guo YM, Yang QX. The utility of measuring the apparent diffusion coefficient for peritumoral zone in assessing infiltration depth of endometrial cancer. Cancer Imaging 2018;18(1):23.
  • Tamai K, Koyama T, Saga T, Umeoka S, Mikami Y, Fujii S, Togashi K. Diffusion-weighted MR imaging of uterine endometrial cancer. J Magn Reson Imaging 2007; 26:682-7.
  • Kishimoto K, Tajima S, Maeda I, Takagi M, Ueno T, Suzuki N, Nakajima Y. Endometrial cancer: correlation of apparent diffusion coefficient (ADC) with tumor cellularity and tumor grade. Acta Radiol 2016;57(8):1021-8.
  • Woo S, Cho JY, Kim SY, Kim SH. Histogram analysis of apparent diffusion coefficient map of diffusion-weighted MRI in endometrial cancer: a preliminary correlation study with histological grade. Acta Radiol 2014;55(10):1270-7.

The Usefulness of Diffusion-Weighted Magnetic Resonance Imaging in Endometrium Cancer Staging

Year 2020, Volume: 9 Issue: 1, 20 - 27, 08.04.2020

Abstract

OBJECTIVE: The goal of this study is to determine the applicability and valuableness of diffusion-weighted magnetic resonance imaging (MRG) in endometrial carcinoma, and to investigate the contribution of obtained results to preoperative tumour staging.
MATERIAL AND METHOD: While the study group included 26 patients who were histopathologically diagnosed endometrial carcinoma, the control group involved 20 patients without any uterine pathology. All patients were applied pelvic MRG for tumour staging. In addition, diffusion-weighted images were obtained with their being scanned in axial plan with planary spin-eco images having 0, 500 ve 1000 s/mm² B value by using 1.5-T MR. Analysis and apparent diffusion coefficient (ADC) measurements of cases were performed by transferring these images to stand-alone workstation (Leonardo console, software version 2.0). ADC measurements in the study group were carried out by using circular ROI (region of interest) from three different points of tumour tissue. It was made by using ROI, normal cervical tissue, endometrium and myometrium in the control group. 3 different ROI values were averaged for each ADC measurement, and mean ADC values were compared with each other.
RESULTS: The average age of the patients in the study group was 60.42 ± 7.68 and 58.60 ± 8.11 in the control group. Mean ADC values were found 0.75±0.16x10¯³ mm²/s in the study group and 1.45±0.10x10¯³ mm²/s in the control group. There was a statistically significant difference between the two groups in terms of mean ADC values (p = 0.01). However, no significant difference was found between the histological grade and ADC values of the cases in the study group (p> 0.05).
CONCLUSION: Mean ADC values measured on diffusion MRI can be used effectively to distinguish between cancerous and normal endometrial tissue, contribute significantly to the surgical management of cancer case and preoperative tumour staging.

References

  • Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics,2014. CA Cancer J Clin 2014; 64(1): 9–29.
  • Rockall AG, Meroni R, Sohaib SA, Reynolds K, Alexander-Sefre F, Shepherd JH, Jacobs I, Reznek RH. Evaluation of endometrial carcinoma on magnetic resonance imaging.Int.J.Gynecol. Cancer. 2007; 17 (1): 188 – 96.
  • Atalay F, Çetinkaya K, Bacınoglu A. Is the 2009 FIGO staging system really valuable for stage I endometrial cancer? Eur J Gynecol Oncol 2013. 34:556-8.
  • Larson DM, Connor GP, Broste SK, Krawisz BR, Johnson KK. Prognostic significance of gross myometrial invasion with endometrial cancer. Obstet Gynecol. 1996; 88 (3): 394 – 8
  • Görker S, Harma M, Harma Mİ. Endometrial Cancer General Perspectives, Epidemiology. Current Obstetrics and Gynecology Reports. 2019: 1-3.
  • Patel S, Liyanage SH, Sadhev A, et al. Imaging of endometrial and cervical cancer. Insights Imaging 2010, 1:309-28.
  • Funda ATALAY, Kadir ÇETİNKAYA. Myometrial Invasion In Endometrial Cancer Patients: Can Magnetic Resonance Imaging Predict The Myometrial Invasion Before Surgery? The Journal of Gynecology - Obstetrics and Neonatology. 2016;13(2): 55-7
  • John L. Currie, Malignant Tumors of the Uterine Corpus in, John D. Thompson, John A. Rock, Te Linde’s Operative Gynecology, Seventh Edition, J.B. Lippincott Company, 1992;1263
  • Koyama T, Tamai K, Togashi K. Sataging of carcinoma of the uterine cervix and endometrium. Eur Radiol, 2007, 17: 2009-19
  • Hricak H, Stern JL, Fisher MR, et al. Endometrial carcinoma staging by MR imaging. Radiology 1987, 162:297-305.
  • Whittaker CS, Coady A, Culver L, Rustin G, Padwick M, Padhani AR. Diffusion weighted MR imaging of female pelvic tumors: a pictorial review. Radiographics. 2009;29(3):759–74. discussion 774-7.
  • Shen SH, Chiou YY, Wang JH, Yen MS, Lee RC, Lai CR, Chang CY. Diffusion-weighted single-shot echo-planar imaging with parallel technique in assessment of endometrial cancer. AJR Am J Roentgenol. 2008; 190:481-88.
  • Wang J, Yu T, Bai R, Sun H, Zhao X, Li Y. The value of the apparent Diffusion Coefficient in differentiating stage 1A endometrial carcinoma from normal endometrium and benign diseases of the endometrium: Initial study at 3-T Mag. Resonance Scanner. J Comput Assist Tomog 2010; 34:332-37.
  • Inada Y, Matsuki M, Nakai G, Tatsugami F, Tanikake M, Narabayashi I, Yamada T, Tsuji M. Body diffusion-weighted MR imaging of uterine endometrial cancer:is it helpful in the detection of cancer in nonenhanced MR imaging? Eur J Radiol 2009; 70:122-27.
  • Lin G, Ng KK, Chang CJ, Wang JJ, Ho KC, Yen TC, Wu TI, Wang CC, Chen YR, Huang YT, Ng SH, Jung SM, Chang TC, Lai CH. Myometrial invasion in endometrial cancer: diagnostic accuracy of diffusion-weighted 3.0-T MR imaging–initial experience. Radiology. 2009; 250(3): 784–92.
  • Rechichi G, Galimberti S, Signorelli M, Perego P, Valsecchi MG, Sironi S. Myometrial invasion in endometrial cancer: diagnostic performance of diffusion-weighted MR imaging at 1.5 T. Eur Radiol 2010;20:754-762.
  • Creasman W.: Revised FIGO staging for carcinoma of the endometrium. Int J Gynaecol Obstet 2009; 105: pp. 109
  • Colagrande S, Pallotta S, Vanzulli A, Napolitano M, Villari N. The diffusion parameter in magnetic resonance: physics, techniques, and semeiotics. La Radiologia Medica. 2005;109 (1–2):1–16.
  • Rechichi G, Galimberti S, Signorelli M, Franzesi CT, Perego P, Valsecchi MG, Sironi S. Endometrial cancer: correlation of apparent diffusion coefficient. with tumor grade, depth of myometrial invasion, and presence of lymph node metastases AJR Am J Roentgenol. 2011;197(1):256–62.
  • Brown H. K, Stoll B. S, Nicosia S. V, et al: Uterine junctional zone: Corelation between histologic findings and MR imaging. Radiology 179:409-413,1991
  • Deng L, Wang QP, Yan R, Duan XY, Bai L, Yu N, Guo YM, Yang QX. The utility of measuring the apparent diffusion coefficient for peritumoral zone in assessing infiltration depth of endometrial cancer. Cancer Imaging 2018;18(1):23.
  • Tamai K, Koyama T, Saga T, Umeoka S, Mikami Y, Fujii S, Togashi K. Diffusion-weighted MR imaging of uterine endometrial cancer. J Magn Reson Imaging 2007; 26:682-7.
  • Kishimoto K, Tajima S, Maeda I, Takagi M, Ueno T, Suzuki N, Nakajima Y. Endometrial cancer: correlation of apparent diffusion coefficient (ADC) with tumor cellularity and tumor grade. Acta Radiol 2016;57(8):1021-8.
  • Woo S, Cho JY, Kim SY, Kim SH. Histogram analysis of apparent diffusion coefficient map of diffusion-weighted MRI in endometrial cancer: a preliminary correlation study with histological grade. Acta Radiol 2014;55(10):1270-7.
There are 24 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Original Article
Authors

Alev Günaldı This is me 0000-0003-3142-823X

Onur Günaldı This is me 0000-0002-5202-7710

Ahmet Tan Cımıllı This is me 0000-0001-7500-7707

Publication Date April 8, 2020
Submission Date April 10, 2019
Published in Issue Year 2020 Volume: 9 Issue: 1

Cite

APA Günaldı, A., Günaldı, O., & Cımıllı, A. T. (2020). Endometriyal Kanser Evrelemesinde Difüzyon Ağırlıklı Manyetik Rezonans Görüntülemenin Yararı. Abant Medical Journal, 9(1), 20-27.
AMA Günaldı A, Günaldı O, Cımıllı AT. Endometriyal Kanser Evrelemesinde Difüzyon Ağırlıklı Manyetik Rezonans Görüntülemenin Yararı. Abant Med J. April 2020;9(1):20-27.
Chicago Günaldı, Alev, Onur Günaldı, and Ahmet Tan Cımıllı. “Endometriyal Kanser Evrelemesinde Difüzyon Ağırlıklı Manyetik Rezonans Görüntülemenin Yararı”. Abant Medical Journal 9, no. 1 (April 2020): 20-27.
EndNote Günaldı A, Günaldı O, Cımıllı AT (April 1, 2020) Endometriyal Kanser Evrelemesinde Difüzyon Ağırlıklı Manyetik Rezonans Görüntülemenin Yararı. Abant Medical Journal 9 1 20–27.
IEEE A. Günaldı, O. Günaldı, and A. T. Cımıllı, “Endometriyal Kanser Evrelemesinde Difüzyon Ağırlıklı Manyetik Rezonans Görüntülemenin Yararı”, Abant Med J, vol. 9, no. 1, pp. 20–27, 2020.
ISNAD Günaldı, Alev et al. “Endometriyal Kanser Evrelemesinde Difüzyon Ağırlıklı Manyetik Rezonans Görüntülemenin Yararı”. Abant Medical Journal 9/1 (April 2020), 20-27.
JAMA Günaldı A, Günaldı O, Cımıllı AT. Endometriyal Kanser Evrelemesinde Difüzyon Ağırlıklı Manyetik Rezonans Görüntülemenin Yararı. Abant Med J. 2020;9:20–27.
MLA Günaldı, Alev et al. “Endometriyal Kanser Evrelemesinde Difüzyon Ağırlıklı Manyetik Rezonans Görüntülemenin Yararı”. Abant Medical Journal, vol. 9, no. 1, 2020, pp. 20-27.
Vancouver Günaldı A, Günaldı O, Cımıllı AT. Endometriyal Kanser Evrelemesinde Difüzyon Ağırlıklı Manyetik Rezonans Görüntülemenin Yararı. Abant Med J. 2020;9(1):20-7.