Recess or Lymphadenopathy? Role of Dynamic Diffusion MRI in Differentiating Right Lower Paratracheal Lesions

Abstract

Objective: The aim of this study was to evaluate the accuracy of dynamic diffusion magnetic resonance imaging (MRI) in the identification of recesses that were interpreted as lower paratracheal LAP on thoracic CT, resulting in unnecessary procedures. Methods: This study included 211 patients who underwent dynamic thoracic MR and CT at our hospital between March 2016 and February 2017. Results: High-riding superior pericardial recess (HSPR) was observed on dynamic MRI in 118 patients. On CT, this structure was interpreted as the HSPR in 98 (83.1%) of these patients and as the lower right paratracheal LAP in 20 patients (16.9%). The mean largest diameter of the areas interpreted as HSPR in both modalities was 13.9±8.7 mm on dynamic MR images and 12.1 ± 6.7 mm on CT images. This difference was statistically significant (P=.04). Areas interpreted as HSPR on dynamic MRI and lower right paratracheal LAP on CT were significantly larger than those interpreted as lower right paratracheal LAP in both modalities (P=.03). Conclusion: Compared with thoracic CT, dynamic MRI may be more effective for lung cancer staging and preventing unnecessary diagnostic procedures and long-term follow-up because of misinterpretation of the pericardial recess as a lower right paratracheal LAP.

Keywords

• Computed tomography
• diffusion magnetic resonance imaging
• high-riding superior pericardial recess

Recess mi?, Lenfadenopati mi?; Sağ Alt Paratrakeal Alandaki Bu Karışıklılığı Gidermede Dinamik Difüzyon Manyetik Rezonans Görüntülemenin Yeri

Abstract

Amaç: Çalışmamızda toraks bilgisayarlı tomografide alt paratrakeal lenfadenopati olarak yorumlanarak gereksiz işlemler uygulanan reseslerin toraks dinamik difüzyon manyetik rezonans (MR) ile doğruluğunu teyit etmeyi amaçladık. Yöntemler: Hastanemizde Mart 2016-Şubat 2017 tarihleri arasında toraks dinamik MR ve toraks BT çekilen 211 hasta çalışmamıza dahil edildi. Hastaların dinamik MR ve toraks BT görüntüleri iki farklı radyoloji uzmanı tarafınca değerlendirilip sonuçları yorumlandı. Bulgular: Dinamik MR değerlendirme sonucunda 118 hastada superior perikardiyal boşluk (HSPR) gözlendi. Bu hastaların 98’inde (%83,1) BT’de bu oluşun HSPR lehine değerlendirilmesine rağmen 20’sinde (%16,9) sağ alt paratrakeal LAP olarak yorumlandı. Her iki incelemede de HSPR olarak yorumlanan alanın en geniş çaplarının ortalamalarının değerlendirmesinde dinamik MR’da 13,9±8,7 mm iken BT’de 12,1±6,7 olarak gözlendi. İki radyolojik değerlendirme arasında ise istatistiksel olarak anlamlı düzeyde farklılık gözlendi (P=,04). Toraks dinamik MR’da HSPR olarak değerlendirilen toraks BT’de HSPR ve sağ alt paratrakeal LAP olarak yorumlanan lezyonların ortalama çaplarının karşılaştırmasında ise sağ alt paratrakeal LAP olarak yorumlanan lezyonların istatistiksel olarak anlamlı düzeyde yüksek olduğu gözlendi (P=,03). Sonuç: Dinamik MR; özellikle yanlışlık ile sağ alt paratrakeal LAP olarak değerlendirilerek akciğer kanseri evrelendirilmesi başta olmak üzere, gereksiz tanısal işlem ve uzun süreli takiplerin önüne geçmede toraks BT’ye nazaran daha etkili olabilir.

Keywords

• Bilgisayarlı tomografi
• difüzyon manyetik rezonans görüntüleme
• superior perikardiyal boşluk

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