Araştırma Makalesi
BibTex RIS Kaynak Göster

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

Yıl 2020, Cilt: 19 Sayı: 3, 143 - 149, 30.12.2020
https://doi.org/10.17941/agd.839289

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.

Kaynakça

  • 1. Okuda K, Ohnishi K, Kimura K, et al. Incidence of portal vein thrombosis in liver cirrhosis. An angiographic study in 708 patients. Gastroenterology 1985;89:279‐86.
  • 2. Demirci H, Öztürk K, Uygun A. Portal Vein Thrombosis. J Clin Anal Med 2015;6(Suppl 4):587-9.
  • 3. İnan M, Sarıoğlu T, Serhat TH. Portomesenteric venous thrombosis as a rare cause of acute abdomen in a young patient: What should be the process of diagnosis and management?. Ulus Cerrahi Derg 2013;29:84-7.
  • 4. Tavusbay C, Kamer E, Acar T, et al. Portal vein thrombosis as a rare cause of abdominal pain: When to consider? Turk J Surg 2017;33:126-9.
  • 5. Sotiropoulos GC, Radtke A, Schmitz KJ, et al. Liver transplantation in the setting of hepatocellular carcinoma and portal vein thrombosis: a challenging dilemma? Dig Dis Sci 2008;53:1994‐9.
  • 6. Takizawa D, Kakizaki S, Sohara N, et al. Hepatocellular carcinoma with portal vein tumor thrombosis: clinical characteristics, prognosis, and patient survival analysis. Dig Dis Sci 2007;52:3290‐5.
  • 7. Sakata J, Shirai Y, Wakai T, et al. Preoperative predictors of vascular invasion in hepatocellular carcinoma. Eur J Surg Oncol 2008;34:900‐5.
  • 8. Catalano OA, Choy G, Zhu A, Hahn PF, Sahani DV. Differentiation of malignant thrombus from bland thrombus of the portal vein in patients with hepatocellular carcinoma: application of diffusion-weighted MR imaging. Radiology 2010;254:154‐62.
  • 9. Harding DJ, Perera MT, Chen F, Olliff S, Tripathi D. Portal vein thrombosis in cirrhosis: Controversies and latest developments. World J Gastroenterol 2015;21:6769‐84.
  • 10. Fujiyama S, Saitoh S, Kawamura Y, et al. Portal vein thrombosis in liver cirrhosis: incidence, management, and outcome. BMC Gastroenterol 2017;17:112.
  • 11. Cohen J, Edelman RR, Chopra S. Portal vein thrombosis: a review. Am J Med 1992;92:173‐82.
  • 12. Sandrasegaran K, Tahir B, Nutakki K, et al. Usefulness of conventional MRI sequences and diffusion-weighted imaging in differentiating malignant from benign portal vein thrombus in cirrhotic patients. AJR Am J Roentgenol 2013;201:1211‐9.
  • 13. Tarantino L, Francica G, Sordelli I, et al. Diagnosis of benign and malignant portal vein thrombosis in cirrhotic patients with hepatocellular carcinoma: color Doppler US, contrast-enhanced US, and fine-needle biopsy. Abdom Imaging 2006;31:537‐44.
  • 14. Gawande R, Jalaeian H, Niendorf E, et al. MRI in differentiating malignant versus benign portal vein thrombosis in patients with hepatocellular carcinoma: Value of post contrast imaging with subtraction. Eur J Radiol 2019;118:88‐95.
  • 15. Tublin ME, Dodd GD 3rd, Baron RL. Benign and malignant portal vein thrombosis: differentiation by CT characteristics. AJR Am J Roentgenol 1997;168:719‐23.
  • 16. Elmas N, Harman M. Karaciğerin vasküler hastalıkları. Trd Sem 2015;3:394-405.
  • 17. Battal B, Kocaoglu M, Akgun V, et al. Diffusion-weighted imaging in the characterization of focal liver lesions: efficacy of visual assessment. J Comput Assist Tomogr 2011;35:326‐31.
  • 18. Xu PJ, Yan FH, Wang JH, et al. Contribution of diffusion-weighted magnetic resonance imaging in the characterization of hepatocellular carcinomas and dysplastic nodules in cirrhotic liver. J Comput Assist Tomogr 2010;34:506‐12.
  • 19. Miller FH, Hammond N, Siddiqi AJ, et al. Utility of diffusion-weighted MRI in distinguishing benign and malignant hepatic lesions. J Magn Reson Imaging 2010;32:138‐47.
  • 20. Taouli B, Koh DM. Diffusion-weighted MR imaging of the liver. Radiology 2010;254:47‐66.
  • 21. Sandrasegaran K, Akisik FM, Lin C, et al. The value of diffusion-weighted imaging in characterizing focal liver masses. Acad Radiol 2009;16:1208‐14.
  • 22. Parikh T, Drew SJ, Lee VS, et al. Focal liver lesion detection and characterization with diffusion-weighted MR imaging: comparison with standard breath-hold T2-weighted imaging. Radiology 2008;246:812‐22.
  • 23. Aumann EK, Server S, Koyuncu Sokmen B, et al. Diagnostic performances of intravoxel incoherent motion and conventional diffusion-weighted imaging in the differential diagnosis of benign and malignant portal vein thrombus. Abdom Radiol (NY) 2018;43:2270‐6.
  • 24. Shah ZK, McKernan MG, Hahn PF, Sahani DV. Enhancing and expansile portal vein thrombosis: value in the diagnosis of hepatocellular carcinoma in patients with multiple hepatic lesions. AJR Am J Roentgenol 2007;188:1320‐3.
  • 25. Connolly GC, Chen R, Hyrien O, et al. Incidence, risk factors and consequences of portal vein and systemic thromboses in hepatocellular carcinoma. Thromb Res 2008;122:299-306.
  • 26. Ahn JH, Yu JS, Cho ES, et al. Diffusion-weighted MRI of malignant versus benign portal vein thrombosis. Korean J Radiol 2016;17:533‐40.
  • 27. Peak AS, Sheller A. Risk factors for developing gadolinium-induced nephrogenic systemic fibrosis. Ann Pharmacother 2007;41:1481‐5.

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

Yıl 2020, Cilt: 19 Sayı: 3, 143 - 149, 30.12.2020
https://doi.org/10.17941/agd.839289

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: , , ,

Kaynakça

  • 1. Okuda K, Ohnishi K, Kimura K, et al. Incidence of portal vein thrombosis in liver cirrhosis. An angiographic study in 708 patients. Gastroenterology 1985;89:279‐86.
  • 2. Demirci H, Öztürk K, Uygun A. Portal Vein Thrombosis. J Clin Anal Med 2015;6(Suppl 4):587-9.
  • 3. İnan M, Sarıoğlu T, Serhat TH. Portomesenteric venous thrombosis as a rare cause of acute abdomen in a young patient: What should be the process of diagnosis and management?. Ulus Cerrahi Derg 2013;29:84-7.
  • 4. Tavusbay C, Kamer E, Acar T, et al. Portal vein thrombosis as a rare cause of abdominal pain: When to consider? Turk J Surg 2017;33:126-9.
  • 5. Sotiropoulos GC, Radtke A, Schmitz KJ, et al. Liver transplantation in the setting of hepatocellular carcinoma and portal vein thrombosis: a challenging dilemma? Dig Dis Sci 2008;53:1994‐9.
  • 6. Takizawa D, Kakizaki S, Sohara N, et al. Hepatocellular carcinoma with portal vein tumor thrombosis: clinical characteristics, prognosis, and patient survival analysis. Dig Dis Sci 2007;52:3290‐5.
  • 7. Sakata J, Shirai Y, Wakai T, et al. Preoperative predictors of vascular invasion in hepatocellular carcinoma. Eur J Surg Oncol 2008;34:900‐5.
  • 8. Catalano OA, Choy G, Zhu A, Hahn PF, Sahani DV. Differentiation of malignant thrombus from bland thrombus of the portal vein in patients with hepatocellular carcinoma: application of diffusion-weighted MR imaging. Radiology 2010;254:154‐62.
  • 9. Harding DJ, Perera MT, Chen F, Olliff S, Tripathi D. Portal vein thrombosis in cirrhosis: Controversies and latest developments. World J Gastroenterol 2015;21:6769‐84.
  • 10. Fujiyama S, Saitoh S, Kawamura Y, et al. Portal vein thrombosis in liver cirrhosis: incidence, management, and outcome. BMC Gastroenterol 2017;17:112.
  • 11. Cohen J, Edelman RR, Chopra S. Portal vein thrombosis: a review. Am J Med 1992;92:173‐82.
  • 12. Sandrasegaran K, Tahir B, Nutakki K, et al. Usefulness of conventional MRI sequences and diffusion-weighted imaging in differentiating malignant from benign portal vein thrombus in cirrhotic patients. AJR Am J Roentgenol 2013;201:1211‐9.
  • 13. Tarantino L, Francica G, Sordelli I, et al. Diagnosis of benign and malignant portal vein thrombosis in cirrhotic patients with hepatocellular carcinoma: color Doppler US, contrast-enhanced US, and fine-needle biopsy. Abdom Imaging 2006;31:537‐44.
  • 14. Gawande R, Jalaeian H, Niendorf E, et al. MRI in differentiating malignant versus benign portal vein thrombosis in patients with hepatocellular carcinoma: Value of post contrast imaging with subtraction. Eur J Radiol 2019;118:88‐95.
  • 15. Tublin ME, Dodd GD 3rd, Baron RL. Benign and malignant portal vein thrombosis: differentiation by CT characteristics. AJR Am J Roentgenol 1997;168:719‐23.
  • 16. Elmas N, Harman M. Karaciğerin vasküler hastalıkları. Trd Sem 2015;3:394-405.
  • 17. Battal B, Kocaoglu M, Akgun V, et al. Diffusion-weighted imaging in the characterization of focal liver lesions: efficacy of visual assessment. J Comput Assist Tomogr 2011;35:326‐31.
  • 18. Xu PJ, Yan FH, Wang JH, et al. Contribution of diffusion-weighted magnetic resonance imaging in the characterization of hepatocellular carcinomas and dysplastic nodules in cirrhotic liver. J Comput Assist Tomogr 2010;34:506‐12.
  • 19. Miller FH, Hammond N, Siddiqi AJ, et al. Utility of diffusion-weighted MRI in distinguishing benign and malignant hepatic lesions. J Magn Reson Imaging 2010;32:138‐47.
  • 20. Taouli B, Koh DM. Diffusion-weighted MR imaging of the liver. Radiology 2010;254:47‐66.
  • 21. Sandrasegaran K, Akisik FM, Lin C, et al. The value of diffusion-weighted imaging in characterizing focal liver masses. Acad Radiol 2009;16:1208‐14.
  • 22. Parikh T, Drew SJ, Lee VS, et al. Focal liver lesion detection and characterization with diffusion-weighted MR imaging: comparison with standard breath-hold T2-weighted imaging. Radiology 2008;246:812‐22.
  • 23. Aumann EK, Server S, Koyuncu Sokmen B, et al. Diagnostic performances of intravoxel incoherent motion and conventional diffusion-weighted imaging in the differential diagnosis of benign and malignant portal vein thrombus. Abdom Radiol (NY) 2018;43:2270‐6.
  • 24. Shah ZK, McKernan MG, Hahn PF, Sahani DV. Enhancing and expansile portal vein thrombosis: value in the diagnosis of hepatocellular carcinoma in patients with multiple hepatic lesions. AJR Am J Roentgenol 2007;188:1320‐3.
  • 25. Connolly GC, Chen R, Hyrien O, et al. Incidence, risk factors and consequences of portal vein and systemic thromboses in hepatocellular carcinoma. Thromb Res 2008;122:299-306.
  • 26. Ahn JH, Yu JS, Cho ES, et al. Diffusion-weighted MRI of malignant versus benign portal vein thrombosis. Korean J Radiol 2016;17:533‐40.
  • 27. Peak AS, Sheller A. Risk factors for developing gadolinium-induced nephrogenic systemic fibrosis. Ann Pharmacother 2007;41:1481‐5.
Toplam 27 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Makaleler
Yazarlar

Ezgi Güler Bu kişi benim 0000-0002-8028-0350

Egemen Öztürk Bu kişi benim 0000-0002-1167-9990

Mürvet Yüksel Bu kişi benim 0000-0003-0376-4973

Timur Köse Bu kişi benim 0000-0002-5238-9738

Mustafa Harman Bu kişi benim 0000-0001-9234-887X

Ahmet Özütemiz Bu kişi benim 0000-0002-6960-4043

Nevra Elmas Bu kişi benim 0000-0002-0074-5673

Yayımlanma Tarihi 30 Aralık 2020
Yayımlandığı Sayı Yıl 2020 Cilt: 19 Sayı: 3

Kaynak Göster

APA Güler, E., Öztürk, E., Yüksel, M., Köse, T., vd. (2020). Malign ile benign portal ven trombozunun ayrımında 3 Tesla manyetik rezonans görüntülemede difüzyon ağırlıklı görüntülemenin rolü. Akademik Gastroenteroloji Dergisi, 19(3), 143-149. https://doi.org/10.17941/agd.839289

test-5