Malign ile benign portal ven trombozunun ayrımında 3 Tesla manyetik rezonans görüntülemede difüzyon ağırlıklı görüntülemenin rolü

Öz

Giriş ve Amaç: Bu çalışmada malign ile benign portal ven trombozunun ayrımında 3 Tesla manyetik rezonans görüntülemede difüzyon ağırlıklı görüntülemenin rolünün araştırılması amaçlanmaktadır. Gereç ve Yöntem: Ocak 2011 - Aralık 2016 tarihleri arasında 3 Tesla manyetik rezonans görüntüleme ünitesinde elde edilmiş abdomen manyetik rezonans görüntüleme incelemeleri portal ven trombozu mevcut olguları tespit etmek için retrospektif olarak değerlendirildi. Kontrastsız görüntüler ile karşılaştırıldığında arteriyel faz kontrastlı görüntülerde ≥%15 kontrast tutulumu gösteren portal ven trombozu malign olarak kabul edildi. Tromboz saptanan portal venin çapı ölçülüp difüzyon ağırlıklı görüntülerde portal ven trombozu sinyal intensitesi kaydedildi. İki bağımsız gözlemci tarafından malign ve benign portal ven trombozlarının görünür difüzyon katsayısı değerleri ölçüldü. Bulgular: Malign portal ven trombozu bulgusu olan 23 olgu [19 erkek, 4 kadın; ortanca yaş 63 (52-83)] ve benign portal ven trombozu bulgusu olan 14 olgu [5 erkek, 9 kadın; ortanca yaş 65 (47-82)] tespit edildi. Difüzyon ağırlıklı görüntülerde malign ile benign portal ven trombozu sinyal intensitesi yönünden istatistiksel olarak anlamlı fark saptandı (p <0.05). Malign portal ven trombozu ortalama görünür difüzyon katsayısı değerleri benign portal ven trombozundan daha düşük saptandı (p <0.05). Görünür difüzyon katsayısı değerleri ölçümü göz önüne alındığında iki gözlemci arasında güvenirlik yüksek olarak tespit edildi (R1: 0.948). Görünür difüzyon katsayısı değeri ≤1.4 x 10-3mm2/s olduğunda malign portal ven trombozu tanısında duyarlılık ve özgüllük %100 olarak saptandı. Sonuç: 3 Tesla manyetik rezonans görüntülemede difüzyon ağırlıklı görüntüler malign ile benign portal ven trombozu ayrımında tanıya katkı sağlamaktadır. Portal ven trombozunun difüzyon ağırlıklı görüntülerdeki sinyal intensitesi ve görünür difüzyon katsayısı değerleri ile karakterizasyonunun yapılabilmesi özellikle kontrast madde kullanımının uygun olmadığı olgularda önem taşımaktadır.

Anahtar Kelimeler

• Portal ven
• tromboz
• manyetik rezonans görüntüleme
• difüzyon ağırlıklı MRG

The use of diffusion-weighted imaging at 3 Tesla magnetic resonance imaging in differentiating malignant from benign portal vein thrombosis

Öz

Background and Aims: The purpose of this study was to evaluate the use of diffusion-weighted imaging at 3 Tesla magnetic resonance imaging in differentiating malignant from benign portal vein thrombosis. Materials and Method: Abdominal magnetic resonance imaging examinations obtained at 3 Tesla magnetic resonance imaging unit between January 2011 and December 2016 were reviewed retrospectively to identify the cases with portal vein thrombosis. Portal vein thrombosis was considered malignant if it enhanced ≥15% on arterial phase contrast-enhanced images relative to precontrast images. Moreover, the diameter of the portal vein involved with the thrombus was measured, and the signal intensity of the portal vein thrombosis on diffusion-weighted images was recorded. The apparent diffusion coefficient values for malignant and benign portal vein thrombosis were calculated by two independent readers. Results: In this study, 23 patients with malignant portal vein thrombosis [19 men, 4 women; median age 63 years (52–83)] and 14 patients with benign portal vein thrombosis (5 men, 9 women; median age 65 years 47–82)] were identified. Statistically significant difference was observed in signal intensity on diffusion-weighted images (p < 0.05) between malignant and benign portal vein thrombosis. The mean apparent diffusion coefficient values for malignant portal vein thrombosis were significantly lower than those for benign portal vein thrombosis (p < 0.05). Furthermore, there was a high agreement on the calculation of apparent diffusion coefficient values (R1: 0.948) between the two readers. Sensitivity and specificity values were both 100% for the diagnosis of malignant portal vein thrombosis when the apparent diffusion coefficient value was ≤1.4 x 10−3 m2/s. Conclusion: Thus, diffusion-weighted imaging at 3 Tesla magnetic resonance imaging is beneficial for the differentiation of malignant and benign portal vein thrombosis. Characterization of portal vein thrombosis using its signal intensity on diffusion-weighted images and apparent diffusion coefficient values is important in patients in whom the use of contrast media is contraindicated. Key words: , , ,

Anahtar Kelimeler

• Portal vein
• thrombosis
• magnetic resonance imaging
• diffusion-weighted imaging

Kaynakça

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