Gliom Evrelemesinde Patolojik İndekslerin (Ki-67, p53) ve Perfüzyon/Difüzyon MR Parametrelerinin Karşılaştırılması

Year 2018, , 11 - 15, 03.08.2018

Gülhan Ertan , Sıla Ulus Aslı Çakır

https://doi.org/10.18678/dtfd.454072

Abstract

Amaç: Bu çalışmada amacımız, derece II astrositom ve glioblastomların (GBM) difüzyon karakteristiklerini belirlemek ve görünür difüzyon katsayısı (ADC), rölatif serebral kan hacmi (rCBV), Ki-67 ve p53 değerlerinin bu tümörlerin preoperatif sınıflanmasındaki yeterliklerini belirlemektir.

Gereç ve Yöntemler: 2014 ve 2017 yılları arasında derece II diffüz astrositom veya GBM nedeniyle hastanemizde ameliyat edilen 24 hastanın MRG bulguları retrospektif olarak incelendi. ADC ve rCBV değerleri tümörün içinden ve simetrik kontralateral normal beyaz hemisferden ölçüldü. Patoloji raporlarından Ki-67 ve p53 değerleri kaydedildi. Perfüzyon ağırlıklı görüntüleme, difüzyon ağırlıklı görüntüleme, Ki-67 ve p53 değerleri düşük dereceli ve yüksek dereceli astrositomlar arasındaki farklar açısından analiz edildi.

Bulgular: Derece II astrositomlarda, ADC değerleri kontralateral normal hemisfer ile karşılaştırıldığında önemli ölçüde artmış, GBM'lerde ise hafif artmıştır. Yüksek ve düşük dereceli astrositomları ayırt etmek için eşik değerin 2 olarak kabul edildiği rCBV'nin başarısı istatistiksel olarak anlamlıdır ve %100 doğrudur. GBM'lerde min ADC değeri azaldıkça, p53 skoru artmıştır. Benzer şekilde, p53 skoru, kontralateral normal beyaz ak maddede minimum ADC ve GBM'nin ortalama ADC değerleri azaldıkça artmıştır.

Sonuç: Glioblastomları, derece II astrositomlardan ayırt etmek için rCBV değerini 2 kullanmak, dereceyi belirlemek için ADC değerlerine dayanmaktan daha üstündür. GBM'li hastalarda kontralateral hemisferin normal ak maddesindeki ADC değerlerinde görülen düşüş, yaygın bir neoplastik süreç düşüncesini desteklemektedir.

Keywords

p53 proteini, Astrositom, manyetik rezonans görüntüleme, perfüzyon ağırlıklı görüntüleme, difüzyon ağırlıklı görüntüleme, Ki-67

Comparison of Pathological Indexes (Ki-67, p53), and Perfusion/Diffusion MR Parameters in Glioma Staging

Abstract

Aim: In this study, we aim to determine the diffusion characteristics of grade II astrocytomas and glioblastomas (GBM), and to determine the ability of apparent diffusion coefficient (ADC), relative cerebral blood volume (rCBV), Ki-67, and p53 values for the preoperative stratification of these tumors.

Material and Methods: MRI scans of 24 patients who underwent surgery for brain tumors in our hospital between 2014 and 2017 with grade II diffuse astrocytoma or GBM were retrospectively reviewed. The ADC and rCBV values were measured from inside the tumor and from the normal white matter of symmetric contralateral hemisphere. Ki-67 and p53 values were recorded from the pathology reports. Perfusion weighted imaging, diffusion weighted imaging, Ki-67, and p53 values were analyzed for differences between low-grade and high-grade astrocytomas.

Results: In grade II astrocytomas, the ADC values significantly increased compared to contralateral normal hemisphere, while in GBMs they were slightly increased. The success of rCBV using a value of 2 in distinguishing high- and low-grade astrocytomas was statistically significant and 100% accurate. As the min ADC value declined in GBMs the p53 score increased. Similarly, the p53 score increased as the min ADC and the average ADC values of GBM in the contralateral normal white matter (WM) declined.

Conclusion: Utilizing an rCBV value of 2 to distinguish grade II from grade IV astrocytomas is superior to relying on ADC values to predict grade. The decline in the ADC values of GBM in the normal WM of contralateral hemisphere corroborates the notion of a diffuse neoplastic process.

Keywords

p53 protein, Astrocytoma, magnetic resonance imaging, perfusion weighted imaging, diffusion weighted imaging, Ki-67

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