KRANİYAL LEZYONLARIN AYIRICI TANISINDA MAGNETİK REZONANS SPEKTROSKOPİNİN ÖNEMİ VE PATOLOJİ SONUÇLARI İLE KORELASYONU

Abstract

AMAÇ: Kraniyal lezyonlarda tedavi algoritmasının belirlenmesinde operasyon öncesi tanı çok önemlidir. Bu çalışma ile preoperatif yapılan görüntüleme yöntemlerinden magnetik rezonans spektroskopi sonuçlarının patoloji sonuçları ile karşılaştırılması ile tanı koymadaki etkinliğinin ortaya konulması amaçlanmıştır.
GEREÇ VE YÖNTEM: 2016 - 2019 yılları arasında kliniğimizde kranial yer kaplayıcı lezyon nedeniyle opere edilen 75 hasta içerisinden operasyon öncesi magnetik rezonans spektroskopi görüntülemesi yapılan 35 hasta çalışmaya alındı. Biyokimyasal metabolit olarak N-asetil aspartat, kreatin, kolin ve laktat değerleri hesaplandı ve bu değerlere göre konulan preoperatif tanılar postoperatif patoloji sonuçları ile karşılaştırılarak literatür eşliğinde tartışıldı.
BULGULAR: Çalışmaya 20 erkek, 15 kadın toplam 35 hasta dahil edildi. Hastaların yaş aralığı 18 - 82 arasında idi. Magnetik rezonans spektroskopi sonucunda 29 hastada yüksek gradeli glial tümör tanısı kondu. Operasyon sonrası değerlendirme sonucunda 27 hastanın magnetik rezonans spektroskopi sonucu ile patoloji sonuçları uyumlu bulunurken 8 hastada farklılıklar görüldü. Yüksek gradeli glial tümörlerde kolin piki ve kolin/NAA oranında belirgin artma dikkat çekti.
SONUÇ: Kraniyal lezyonların ayırıcı tanısında yapılan magnetik rezonans spektroskopi ile elde edilen preoperatif değerlendirmeler ile patolojik tanı arasında yüksek oranda korelasyon mevcutdur.

Keywords

• Tümör
• Spektroskopi
• Cerrahi
• Patoloji

THE IMPORTANCE OF MAGNETIC RESONANCE SPECTROSCOPY IN THE DIFFERENTIAL DIAGNOSIS OF CRANIAL LESIONS AND ITS CORRELATION WITH PATHOLOGY RESULTS

Abstract

OBJECTIVE: Preoperative diagnosis is very important in determining the treatment algorithm in cranial lesions. The aim of this study is to compare the results of magnetic resonance spectroscopy, which is one of the preoperative imaging methods, with the results of pathology and to reveal its effectiveness in diagnosis.
MATERIAL AND METHODS: Thirty five patients who underwent preoperative magnetic resonance spectroscopy imaging among 75 patients who were operated for cranial lesions in our clinic between 2016 - 2019 were included in the study. N-acetyl aspartate, creatine, choline and lactate values were calculated as biochemical metabolites, and preoperative diagnoses made according to these values were compared with postoperative pathology results and discussed in the light of the literature.
RESULTS: A total of 35 patients, 20 male and 15 female, were included in the study. The age range of the patients was between 18 - 82. As a result of magnetic resonance spectroscopy, 29 patients were diagnosed with high grade glial tumors. As a result of the postoperative evaluation, the magnetic resonance spectroscopy results of 27 patients were found to be compatible with the pathology results, while differences were observed in 8 patients. A significant increase in choline peak and choline / NAA ratio was noted in high-grade glial tumors.
CONCLUSIONS: There is a high correlation between the preoperative evaluations obtained by magnetic resonance spectroscopy which is used in the differential diagnosis of cranial lesions, and the pathological diagnosis.

Keywords

• Tumor
• Spectroscopy
• Surgery
• Pathology

References

1. 1. Fink JR, Muzi M, Peck M, Krohn KA. Continuing education: Multimodality brain tumor imaging - MRI, PET, and PET / MRI. J Nucl Med. 2015;56:1554-61.
2. 2. Warren KE. NMR spectroscopy and pediatric brain tumors. Oncologist. 2004;9(3):312-18.
3. 3. Tosun A, Serifoglu I. Imaging of Central Nervous System Tumors. Acta Med Alanya. 2018;2(1):56-61.
4. 4. Najjar AM, Johnson JM, Schellingerhout D. The emerging role of amino acid PET in neuro-oncolgy. Bioengineering (Basel). 2018;5(4):104.
5. 5. Aksoy FG, Yerli H. Dynamic contrast brain perfusion imaging: technical principles, pitfalls and problems. Journal of diagnostic and interventional radiology. 2003;9:309-14.
6. 6. Patel P, Baradaran H, Delgado D, et al. MR perfusion-weighted imaging in the evaluation of high-grade gliomas after treatment: a systematic review and meta-analysis. Neuro Oncol. 2017;9:118-27.
7. 7. Fleischmann DF, Unterrainer M, Corradini S, et al. Report of rst recurrent glioma patients examined with PET-MRI prior to reirradiation. PLoS One. 2019;14:e0216111.
8. 8. Langen KJ, Galldiks N, Hattingen E, Shah NJ. Advances in neuro-oncology imaging. Nature Reviews. Neurol. 2017;13:279-89.

9. 9. Law M, Yang S, Wang H, et al. Glioma grading: sensitivity, specificity, and predictive values of perfusion MR imaging and proton MR spectroscopic imaging compared with conventional MR imaging. Am J Neuroradiol. 2003;24:1989-98.
10. 10. Bulakbasi N, Kocaoglu M, Ors F, Tayfun C, Ucoz T. Combination of single-voxel proton MR spectroscopy and apparent diffusion coefficient calculation in the evaluation of common brain tumors. AJNR Am J Neuroradiol. 2003;24(2):225-33.
11. 11. Howe FA, Barton SJ, Cudlip SA, et al. Metabolic proles of human brain tumors using quantitative in vivo 1H magnetic resonance spectroscopy. Magn Reson Med. 2003;49:223-32.
12. 12. McNeill KA. Epidemiology of brain tumors. Neurol Clin. 2016;34:981-98.
13. 13. Esen ÖS, Bozkurt M, Adıbelli ZH, et al. Diagnostic value of proton mr spectroscopy in brain tumors. Tepecik Ed Med J. 2014;24(2):93-98.
14. 14. Mauler J, Maudsley AA, Langen KJ, et al. Spatial Relationship of Glioma Volume Derived from 18F-FET PET and Volumetric MR Spectroscopy Imaging: A Hybrid PET/MRI Study. J Nucl Med. 2018;59:603-9.
15. 15. Kwock L, Smith JK, Castillo M et al. Clinical applications of proton MR spectroscopy in oncology. Technol Cancer Res Treat. 2002;1:17- 28.
16. 16. Kim TK, Chang KH, Kim CJ, Goo JM, Kook MC, Han MH. Intracranial tuberculoma: comparison of MR with pathologic findings. AJNR Am J Neuroradiol. 1995;16(9):1903-8.
17. 17. Khanna PC, Godinho S, Patkar DP, Pungaukar SA, Lawande MA. MR spectroscopy-aided differentiation: "giant" extra-axial tuberculoma masquerading as meningioma. AJNR Am J Neuroradiol. 2006;27(7):1438-40.
18. 18. Morales H, Alfaro H, Martinot C, Fayed N, Shipley MG. MR spectroscopy of intracranial tuberculomas: A singlet peak at 3.8 ppm as potential marker to differentiate them from malignant tumors. Neuroradiol J. 2015;28(3):294–302.
19. 19. Brunetti A, Alfano B, Soricelli A, Tedeschi E, Mainolfi C, Covelli EM. Functional characterization of brain tumors: An overviev of potential clinical value. Nuclear Medicine & Biology. 1996;23:699-715 .