Endometriyal Kanser Evrelemesinde Difüzyon Ağırlıklı Manyetik Rezonans Görüntülemenin Yararı

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

Alev Günaldı Onur Günaldı Ahmet Tan Cımıllı

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.

Keywords

Endometrium kanseri, Manyetik rezonans görüntüleme, ADC değerleri

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

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.

Keywords

Endometrial carcinoma, Magnetic resonance imaging, ADC values

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