Kraniyal Lezyonlarda Gradient T2*- Ağırlıklı Manyetik Rezonans Görüntülemenin Tanısal Katkısı

Year 2021, Volume: 3 Issue: 2, 74 - 80, 01.07.2021

Nurdan Göçgün , Türkan İkizceli

https://doi.org/10.38175/phnx.915061

Abstract

Amaç: Manyetik rezonans görüntülemede sekanslarından “gradient recalled echo” diğer görüntüleme metotlarıyla görülemeyen mikro kanamaların ortaya konmasında önemli rol oynamaktadırlar. Bu çalışmada kanama harici diğer hastalarda gradient T2*-ağırlıklı sekansın tanıya katkısı sunuldu.
Gereç ve Yöntemler: Ocak 2018- Aralık 2019 tarihleri arasında tanısal amaçlı kraniyal manyetik rezonans görüntüleme yapılmış ve standart sekanslarına ek olarak gradient T2* içeren görüntülemeleri olan 47 hasta geriye dönük olarak çalışmaya dâhil edildi. Lezyonlar etyolojik nedenlerine göre üç grup altında sınıflandı; vasküler, kitle ve diğer nedenler. Lezyonların gradient sekanstaki lokalizasyonları, sayıları, boyutları, intensiteleri, post.kontrast bilgileri ve blooming artefaktının varlığı değerlendirildi.
Bulgular: 33’si erkek, 14’si kadın 47 olgunun yaş aralığı 27-93’ydi, ortalama yaş 58.32±16.67. Olgulardan 33’ü (%70) vasküler nedenli, 6’sı kitle (%13) ve 8’i “diğer” (%17) grubundaydı. Vasküler lezyonlar arasında hipertansif ve amiloid mikroanjiopati, serebrovasküler olay, kanama, venöz tromboz, vasküler malformasyon, vasküler malformasyon-kanama yer almaktaydı. Kitlelerin 3’ü hemorajik metastaz, diğerleri kalsifik menenjiom, oligoastrositom, hemanjioblastomdu. ‘Diğer’ grubunda ise infeksiyon (tüberküloz granulomları, toxoplazma), inme taklitçisi (laminar nekroz, kalsifikasyon), hipofiz apopleksisi, FAHR sendromu ve metakromatik lökodistrofi, nefrotoksisiteye bağlı madde birikimi vardı. Gradient T2* sekans bulguları olgulara tanı koydurucu veya tanıyı güçlendirici etkisi olmuştur.
Sonuç: Gradient T2*-Ağırlıklı görüntüleme vasküler hastalıklardaki bilinen değeri yanında non-vasküler santral sinir sistemi hastalıklarında da tanıyı güçlendirmektedir.

Keywords

kraniyal lezyonlar, nöroradyoloji, Gradient T2*- Ağırlıklı görüntüleme

Thanks

Sağlık Bilimleri Üniversitesi Nöroloji Bölümü'nden Doç.Dr. Birgül Baştan'a katkılarından dolayı teşekkür ederiz.

Diagnostic Contribution of Gradient T2*-Weighted Magnetic Resonance Imaging in Cranial Lesions

Abstract

Objective: “Gradient recalled echo” sequences on magnetic resonance imaging (MRI) plays an important role in detecting micro bleeding that cannot be seen by other imaging methods. In this study, we aimed to show that the contribution of gradient T2*-weighted sequence in other diseases except for hemorrhage to diagnosis.
Materials and Methods: Forty-seven patients who underwent diagnostic cranial MRI with gradient T2*-weighted sequence in addition to their standard sequences between January 2018 and December 2019 were included in the study retrospectively. Lesions were classified into three groups according to etiological reasons; vascular, mass, and others. Lesion localization, numbers, sizes, intensities, post-contrast information, and the presence of blooming artifacts were evaluated.
Results: The age range of 47 patients (33 men and 14 women) was 27-93, the mean age was 58.32±16.67. 33 (70%) of the cases were due to vascular causes, 6 of them were in the mass (13%) and 8 of them were in the "other" (17%) group. Vascular lesions included hypertensive and amyloid microangiopathy, cerebrovascular event, hemorrhage, venous thrombosis, vascular malformation, vascular malformation-hemorrhage. Three of the masses were hemorrhagic metastasis, others were calcific meningioma, oligoastrocytoma, hemangioblastoma. In the 'Others' group, there were infections (tuberculosis, toxoplasma), stroke (laminar necrosis, calcification), pituitary apoplexy, FAHR syndrome, metachromatic leukodystrophy, and substance accumulation due to nephrotoxicity. Gradient T2 * sequence findings were diagnostic or contributing to the diagnosis.
Conclusion: Besides its known value in Gradient T2*-weighted imaging in vascular diseases, it also contribute to the diagnosis in non-vascular central nervous system diseases.

Keywords

Gradient T2*-Weighted imaging, cranial lesions, neuroradiology

References

• Tsushima Y, Endo K. Hypointensities in the brain on T2*-weighted gradient-echo magnetic resonance imaging. Curr Probl Diagn Radiol. 2006; 35:140–150.
• Reichenbach JR, Venkatesan R, Schillinger DJ, Kido DK, Haacke EM. Small veins in humans brain: MR venography as intrinsic contrast agent with deoxyhemoglobin. Radiology. 1997; 204:272-277.
• Frahm J, Haenicke W. Rapid scan techniques. In: Stark DD, Bradley WG, eds. Magnetic resonance imaging. 3rd ed. St Louis, Mo: Mosby, 1999;87-124.
• Thamburaj K, Radhakrishnan VV, Thomas B, Nair S, Menon G. Intratumoral microhemorrhages on T2*-weighted gradient-echo imaging helps differentiate vestibular schwannoma from meningioma. AJNR Am J Neuroradiol. 2008; 29:552-557.
• Tosaka M, Sato N, Hirato J, Fujimaki H, Yamaguchi R, Kohga H, et al. Assessment of hemorrhage in pituitary macroadenoma by T2 *- weighted gradient-echo MR imaging. AJNR Am J Neuroradiol. 2007; 28:2023-2029.
• Rovira A, Orellana P, Alvarez-Sabin J, Arenillas JF, Aymerich X, Grivé E, et al. Hyperacute ischemic stroke: middle cerebral artery susceptibility sign at echo-planar gradient-echo MR imaging. Radiology. 2004; 232:466-473.
• Govind B. Chavhan, Paul S. Babyn, Bejoy Thomas, Manohar M. Shroff, E. Mark Haacke. Principles, Techniques, and Applications of T2* -based MR Imaging and Its Special Applications. Radiographics. 2009;9(5):1433-1449.
• Koennecke HC. Cerebral microbleeds on MRI. Neurology. 2006; 66:165–171.
• Tsushima Y, Tanizaki Y, Aoki J, Endo K. MR detection of microhemorrhages in neurologically healthy adults. Neuroradiology. 2002; 44:31-36.
• Viswanathan A, Chabriat H. Cerebral microhemorrhage. Stroke. 2006; 37:550-555.
• Barnaure I, Liberato AC, Gonzalez RG, Romero JM. Isolated intraventricular haemorrhage in adults. Br J Radiol. 2017;90(1069):20160779.
• Selim M, Fink J, Linfante I, Kumar S, Schlaug G, Caplan LR. Diagnosis of cerebral venous thrombosis with echo-planar T2*-weighted magnetic resonance imaging. Arch Neurol. 2001; 59:1021-1026.
• Zabramski JM, Wascher TM, Spetzler RF, Johnson B, Golfinos J, Drayer BP, et al. The natural history of familial cavernous malformations: results of an ongoing study. J Neurosurg.1994;80:422-432.
• Coban A, Gurses C, Bilgic B, Sencer S, Karasu A, Bebek N, et al. Sporadic multiple cerebral cavernomatosis: report of a case and review of literature. Neurologist. 2008;14(1):46-49.
• Blitstein MK, Tung GA. MRI of cerebral microhemorrhages. AJR Am J Roentgenol. 2007;189(3):720-725.
• Löbel U, Sedlacik J, Sabin ND, Kocak M, Broniscer A, Hillenbrand CM, et al. Three-dimensional susceptibility-weighted imaging and two-dimensional T2*-weighted gradient-echo imaging of intratumoral hemorrhages in pediatric diffuse intrinsic pontine glioma. Neuroradiology. 2010;52(12):1167-1177.
• Sadeghi N, D'Haene N, Decaestecker C, Levivier M, Metens T, Maris C, et al. Apparent diffusion coefficient and cerebral blood volume in brain gliomas: relation to tumor cell density and tumor microvessel density based on stereotactic biopsies. AJNR Am J Neuroradiol. 2008;29(3):476-482.
• Eichler AF, Loeffler JS. Multidisciplinary management of brain metastases. Oncologist. 2007;12(7):884-898.
• Fink KR, Fink JR. Imaging of brain metastases. Surg Neurol Int. 2013; 2:209-219.
• Bründl E, Schödel P, Ullrich OW, Brawanski A, Schebesch KM. Surgical resection of sporadic and hereditary hemangioblastoma: Our 10-year experience and a literature review. Surg Neurol Int. 2014; 5:138.
• Smits M. Imaging of oligodendroglioma. Br J Radiol. 2016;89(1060):20150857.
• Goyal P, Utz M, Gupta N, Kumar Y, Mangla M, Gupta S, et al. Clinical and imaging features of pituitary apoplexy and role of imaging in differentiation of clinical mimics. Quant Imaging Med Surg. 2018;8(2):219-231.
• Sahin N, Solak A, Genc B, Kulu U. Fahr disease: use of susceptibility-weighted imaging for diagnostic dilemma with magnetic resonance imaging. Quant Imaging Med Surg. 2015;5(4):628-632.
• Resende LL, de Paiva ARB, Kok F, da Costa Leite C, Lucato LT. Adult leukodystrophies: a step-by-step diagnostic approach. Radiographics. 2019;39(1):153-168.
• Kumar G, Goyal MK. Lentiform Fork sign: a unique MRI picture. Is metabolic acidosis responsible? Clin Neurol Neurosurg. 2010;112(9):805-812.