İDİYOPATİK GRANÜLOMATÖZ MASTİT LEZYONLARINDA STEROİD TEDAVİSİNE YANITIN DEĞERLENDİRİLMESİNDE DİFÜZYON AĞIRLIKLI MR GÖRÜNTÜLEMENİN ROLÜ

Yıl 2022, Cilt: 85 Sayı: 4, 456 - 461, 28.10.2022

Günay Rona , Meral Arifoğlu , Nuray Voyvoda , Kenan Çetin , Lale Damgacı

https://doi.org/10.26650/IUITFD.1125446

Öz

Amaç: Bu çalışmanın amacı, idiyopatik granülomatöz mastit (İGM) lezyonlarının steroit tedavisine yanıtını değerlendirmede, görünür bir difüzyon katsayısı (ADC) haritası ile difüzyon ağırlıklı manyetik rezonans görüntülemenin (DW MRG) rolünü araştırmaktı. Gereç ve Yöntem: Bu retrospektif çalışma, biyopsi ile kanıtlanmış İGM’li 58 kadın (ortalama yaş 32,91 yıl, aralık=22-55 yıl) hastanın 99 lezyonunu içeriyordu. Hastalar oral ve topikal steroidlerle tedavi edildi. Tüm tedavi öncesi ve tedavi sonrası MR incelemeleri değerlendirildi. Kitlelerin ve kitlesel olmayan kontrastlanmaların maksimum boyutu ölçüldü. Tedavi sonrası dinamik kontrastlı (DK) MR bulgularına göre hastalar tam yanıt, kısmi yanıt ve yanıtsız olarak sınıflandırıldı. Bulgular: İGM (0,933±0,317x10-3 mm2/sn) tarafından işgal edilen alanların ADC değerleri, kontralateral normal parankimden (1,259±0,423x10-3 mm2/sn) daha düşüktü. Lezyonların 22’si (%22,22) yanıtsız, 30’u (%30,30) kısmi yanıt ve 47’si tam yanıt (%47,47) grubundaydı. Üç tedavi grubunda tedavi öncesi ADC değerleri arasında anlamlı bir fark yoktu (p=0,228). Kısmi yanıt grubunda tedavi öncesi ve tedavi sonrası ADC değerleri arasında anlamlı fark vardı (p=0,001). Sonuç: İGM’de DW MR görüntüleme, tedaviye yanıtı izlemek için yararlı bir yöntemdir. Ancak tedaviye yanıtı tahmin etmede başarılı değildir. 

Anahtar Kelimeler

Granülomatöz mastitis, Manyetik rezonans görüntüleme, Difüzyon ağırlıklı MRG, Tedavi yanıtı, Steroid tedavisi

Destekleyen Kurum

yok

THE ROLE OF DIFFUSION-WEIGHTED MR IMAGING IN EVALUATING THE RESPONSE TO STEROID THERAPY IN IDIOPATHIC GRANULOMATOUS MASTITIS LESIONS

Öz

Objective: The aim of this study was to investigate the role of diffusion-weighted magnetic resonance imaging (DW MRI) with an apparent diffusion coefficient (ADC) map in evaluating the response to treatment of steroid-treated idiopathic granulomatous mastitis (IGM) lesions. Materials and Methods: This retrospective study included 99 lesions of 58 female patients (average age: 32.91 years; range: 22–55 years) with biopsy-proven IGM. Patients were treated with oral and topical steroids. All pre-treatment and post-treatment MR examinations were evaluated. The maximal size of the masses and nonmass enhancement (NME) lesions were measured. Patients were classified as complete response (CR), partial response (PR), and non-response (NR) according to the dynamic contrast-enhanced (DCE) MR findings after treatment. Results: ADC values of areas occupied by IGM (0.933±0.317x10-3 mm2/sec) were lower than contralateral normal parenchyma (1.259±0.423x10-3 mm2/sec). Twenty-two (22.22%) of the lesions were in the NR group, 30 (30.30%) in the PR group, and 47 (47.47%) in the CR group. There was no significant difference between the pre-treatment ADC values in NR, PR, and CR groups (p=0.228). There was a significant difference between the pre-treatment and post-treatment ADC values in the PR groups (p=0.001). Conclusion: DW MR imaging in IGM is a useful method to monitor the response to treatment. However, it is not successful in predicting response to treatment. 

Anahtar Kelimeler

Granulomatous Mastitis, Magnetic Resonance Imaging, Diffusion-Weighted MRI, Treatment Response, Steroid Therapy

Kaynakça

• 1. Aghajanzadeh M, Hassanzadeh R, Alizadeh Sefat S, Alavi A, Hemmati H, Esmaeili Delshad MS, et al. Granulomatous mastitis: Presentations, diagnosis, treatment and outcome in 206 patients from the north of Iran. Breast 2015;24(4):456-60. [CrossRef] google scholar
• 2. Azizi A, Prasath V, Canner J, Gharib M, Sadat Fattahi A, Naser Forghani M, et al. Idiopathic granulomatous mastitis: Management and predictors of recurrence in 474 patients. Breast J 2020;26(7):1358-62. [CrossRef] google scholar
• 3. Fazzio RT, Shah SS, Sandhu NP, Glazebrook KN. Idiopathic granulomatous mastitis: imaging update and review. Insights Imaging 2016;7(4):531-9. [CrossRef] google scholar
• 4. Pluguez-Turull CW, Nanyes JE, Quintero CJ, Alizai H, Mais DD, Kist KA, et al. Idiopathic Granulomatous Mastitis: Manifestations at Multimodality Imaging and Pitfalls. Radiographics 2018;38(2):330-56. [CrossRef] google scholar
• 5. Hovanessian Larsen LJ, Peyvandi B, Klipfel N, Grant E, Iyengar G. Granulomatous lobular mastitis: imaging, diagnosis, and treatment. AJR Am J Roentgenol 2009;193(2):574-81. [CrossRef] google scholar
• 6. Gautier N, Lalonde L, Tran-Thanh D, El Khoury M, David J, Labelle M, et al. Chronic granulomatous mastitis: Imaging, pathology and management. Eur J Radiol 2013;82(4):e165-75. [CrossRef] google scholar
• 7. Oztekin PS, Durhan G, Nercis Kosar P, Erel S, Hucumenoglu S. Imaging Findings in Patients with Granulomatous Mastitis. Iran J Radiol 2016;13(3):e33900. [CrossRef] google scholar
• 8. Poyraz N, Emlik GD, Batur A, Gundes E, Keskin S. Magnetic Resonance Imaging Features of Idiopathic Granulomatous Mastitis: A Retrospective Analysis. Iran J Radiol 2016;13(3):e20873. [CrossRef] google scholar
• 9. Tse GM, Poon CS, Ramachandram K, Ma TK, Pang LM, Law BK, et al. Granulomatous mastitis: a clinicopathological review of 26 cases. Pathology 2004;36(3):254-7. [CrossRef] google scholar
• 10. Lacambra M, Thai TA, Lam CC, Yu AM, Pham HT, Tran PV, et al. Granulomatous mastitis: the histological differentials. J Clin Pathol 2011;64(5):405-11. [CrossRef] google scholar
• 11. Tang A, Dominguez DA, Edquilang JK, Green AJ, Khoury AL, Godfrey RS. Granulomatous Mastitis: Comparison of Novel Treatment of Steroid Injection and Current Management. J Surg Res 2020;254:300-5. [CrossRef] google scholar
• 12. Postolova A, Troxell ML, Wapnir IL, Genovese MC. Methotrexate in the Treatment of Idiopathic Granulomatous Mastitis. J Rheumatol 2020;47(6):924-7. [CrossRef] google scholar
• 13. Zhou F, Liu L, Liu L, Yu L, Wang F, Xiang Y, et al. Comparison of Conservative versus Surgical Treatment Protocols in Treating Idiopathic Granulomatous Mastitis: A Meta-Analysis. Breast Care (Basel) 2020;15(4):415-20. [CrossRef] google scholar
• 14. Kehribar DY, Duran TI, Polat AK, Ozgen M. Effectiveness of Methotrexate in Idiopathic Granulomatous Mastitis Treatment. Am J Med Sci 2020;360(5):560-5. [CrossRef] google scholar
• 15. Godazandeh G, Shojaee L, Alizadeh-Navaei R, Hessami A. Corticosteroids in idiopathic granulomatous mastitis: a systematic review and meta-analysis. Surg Today 2021;51(12):1897-905. [CrossRef] google scholar
• 16. Çetinkaya G, Kozan R, Emral AC, Tezel E. Granulomatous mastitis, watch and wait is a good option. Ir J Med Sci 2021;190(3):1117-22. [CrossRef] google scholar
• 17. Padhani AR, Liu G, Koh DM, Chenevert TL, Thoeny HC, Takahara T, et al. Diffusion-weighted magnetic resonance imaging as a cancer biomarker: consensus and recommendations. Neoplasia 2009;11(2):102-25. [CrossRef] google scholar
• 18. Nishino M, Jagannathan JP, Ramaiya NH, Van den Abbeele AD. Revised RECIST guideline version 1.1: What oncologists want to know and what radiologists need to know. AJR Am J Roentgenol 2010;195(2):281-9. [CrossRef] google scholar
• 19. Altunkeser A, Arslan FZ, Eryılmaz MA. Magnetic resonance imaging findings of idiopathic granulomatous mastitis: can it be an indirect sign of treatment success or fail? BMC Med Imaging 2019;19(1):94. [CrossRef] google scholar
• 20. Aslan H, Pourbagher A, Colakoglu T. Idiopathic granulomatous mastitis: magnetic resonance imaging findings with diffusion MRI. Acta Radiol 2016;57(7):796-801. [CrossRef] google scholar
• 21. Yilmaz R, Demir AA, Kaplan A, Sahin D, Ozkurt E, Dursun M, et al. Magnetic resonance imaging features of idiopathic granulomatous mastitis: is there any contribution of diffusion-weighted imaging in the differential diagnosis? Radiol Med 2016;121(11):857-66. [CrossRef] google scholar