Konjenital Akciğer Lezyonları: Fetal manyetik Rezonans Görüntüleme, Prenatal Ultrasonografi, Postnatal Düşük Doz Bilgisayarlı Tomografi Angiografi Kullanılarak Yapılan Hacim Ölçümününe Dayalı Lezyon Tipinin Öngörülmesi

Yıl 2018, , 992 - 1009, 15.12.2018

Filiz Çelebi , Monica Epelman Sabah Servaes Teresa Victoria Beverly Coleman Jeffrey Hellinger Oznur Leman Boyunaga

https://doi.org/10.30569/adiyamansaglik.452511

Öz

AMAÇ: Üç ana tip konjenital akciğer lezyonunun hacim ve büyüme oranlarının karşılaştırılması, hacim ölçümünün lezyon karakterizasyonundaki etkinliğinin tanımlanması amaçlanmıştır. GEREÇ VE YÖNTEM: Çalışmamızda patolojik olarak kanıtlanmış konjenital akciğer hastalığı olan 59 infant (0-101 gün) retrospektif olarak değerlendirildi. Görüntüleme yöntemlerinden aynı günde (gestasyonun +/ - 24,4 haftasında) fetal MRG, prenatal US ve postnatal olarak da BTA uygulandı. US hacimleri prenatal ultrason raporlarından alındı. Fetal MRG 1.5 T MRG sistemi ile yapıldı. BTA ise 64-kesitli BT sistemi ile düşük doz protokolü kullanılarak gerçekleştirildi. Daha sonra çalışma istasyonlarında hacim ölçümleri gerçekleştirildi. Lezyonlar 3 ana kategoride sınıflandırıldı: Bronşiyal atrezi (BA), konjenital kistik adenomatoid malformasyon (KKAM) ve bronkopulmoner sekestrayon (BPS). Ancak lezyonların%40‘ından fazlasında birden çok histolojik tipin olduğu görüldü. Tanımlaman lezyonlar ve toplam akciğer hacimleri MRG ve BT görüntülerinden bilgisayar yazılımları kullanılarak hesaplandı. İstatiksel ölçüm; gruplar arası ve sınıfiçi ortalama lezyon hacmindeki anlamlı farklılık degişkenlik analizi, sınıf içi korelasyon ve Fisher Testi kullanılarak yapıldı (p<0.05). BULGULAR: MRG görüntülerinden elde olunan hacim ölçümleri şu şekildedir. BA için 11.6cc (95%CI 7.7-15.1), KKAM için 17.6 cc (95%CI 12.6-22.6) ve BPS için 21.1cc (95% CI 12.8-29.6). Prenatal US hacimleri sırasıyla BA için 9.6cc ( 95%CI6.6-12.7) , KKAM için 18.1cc (95%CI 13.3- 22.9) ve BPS için 16.1cc (95%CI 10.5-25.2). Lezyonların MRG ve US volümleri arasındaki sınıf içi korelasyon katsayısı BA için 0.94 (% 95 CI 0.87-0.98) ve KKAM için 0.95 (% 95 CI 0.87-0.95) olarak tespit edildi. BTA ile; BA için 12.1cc (%95 CI 9.3-15.2), KKAM için 20.8cc (%95 CI 13.0- 28.7), BPS için 20.5cc (%95 CI 12.3-28.6) hacim hesaplandı. SONUÇ: Sonuç olarak çalışmamızdaki bulgular değerlendirildiğinde; MRG ve US ile ölçülen BA ve KKAM hacimleri arasında güçlü bir uyum olduğu görüldü. Literatürde yaklaşık 25. gestasyon haftasında KKAM ‘da pik boyut artışı olduğu bildirilmesine rağmen bizim olgu grubumuzda; prenatal dönemde US ve MRG ile ve postnatal olarak da BTA’da görüldüğü gibi, KKAM’nun salt boyutunda ılımlı artış, BA hacminde göreceli olarak stabil seyir ve BPS hacminde az miktarda düşme olduğu görüldü. Ancak, üç ana tip lezyon hacminde de zaman içerisinde göğüs boşluğu hacminin genişlemesine göreceli olarak azalma olduğu saptandı.

Anahtar Kelimeler

KKAM, Konjenital akciğer lezyonları, Bronşiyal atrezi

Congenital Lung Lesions: Predictability of Lesion Type Based on Volume Analysis Using Fetal MRI, Prenatal Sonography and Postnatal Low-Dose Chest CT Angiography

Öz

PURPOSE: To compare volumes and growth rates of 3 major types of congenital lung lesions (CLL) and to determine if volume measurement can improve lesion characterization. MATERIALS AND METHODS: Retrospective analysis of 59 infants (0- 101days) with pathologically proven CLL was performed. Studies included fetal MRI and prenatal sonography (US) performed the same day at +/- 24.4 weeks gestation, and postnatal CT angiography(CTA). US volumes were extracted from the US reports. Fetal MRI was performed on a 1.5T scanner. CTA studies were acquired in 64-multidetector scanner utilizing a low-dose protocol. Data was transferred to an independent workstation for analysis. Lesion and lung volumes were calculated as described elsewhere. The lesions were classified in 3 main categories: Bronchialatresia (BA), congenital cystic adenomatoid malformation (CCAM), and bronchopulmonary sequestration (BPS), although it should be noted that at least 40%of the lesions suggested more than one histologic type. Statistical analyses was performed using the analysis of variance to identify significant differences in mean lesion volume between groups, intraclass correlation, or Fisher exact tests (P <0 .05). RESULTS: Mean volumetric MR measurements were as follow: 11.6cc (95%CI 7.7-15.1) for BA, 17.6 cc (95%CI 12.6-22.6) for CCAM, and 21.6cc (95% CI 12.8-229.6) for BPS. The intraclass correlation coefficient between MRI and US measurements for the lesions was 0.94(95% CI 0.87-0.98) for BA and 0.95 (95%CI 0.87-0.95%) for CCAM. On postnatal low-dose CTA the mean volumetric measurements were: 12.1 cc (95%CI 9.3-15.2) for BA, 20.9cc (95%CI 13-28.7) for CCAM and 20.5 cc (95%CI 12.4-28.6) for BPS. CONCLUSION: There is good agreement between BA and CCAM volumes measured by MRI and those measured by US. Despite the literature quotes a peak in CCAM size occurring approximately at 25 weeks' gestation, in our series, and as measured by postnatal CTA, we encountered a very mild increase in absolute size of CCAM, with relative stable size of BA and slight decrease in volume of BPS. However, all 3 lesions demonstrated a trend toward decreasing mass volume relative to thoracic cavity volume over time. Larger studies are necessary to confirm these results.

Anahtar Kelimeler

CCAM, Congenital lung lesions, Bronchial atresia

Kaynakça

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