Difüzyon Ağırlıklı Manyetik Rezonans Görüntülemede Hepatoselüler Karsinom ve Karaciğer Metastazı Ayırımında Hedef İşaretinin ve Görünür Difüzyon Katsayısı Ölçümlerinin Tanısal Değeri

Öz

Öz Amaç: Çalışmamızın amacı, metastazlar ve hepatoselüler karsinomlar (HCC) arasındaki difüzyon ağırlıklı manyetik rezonans görüntüleme (DWI) ile tespit edilen hedef işaret insidansı ve görünür difüzyon katsayısı (ADC) değerleri arasındaki olası farklılıkları araştırmaktır. Gereç ve Yöntem: 57 (kadın/erkek: 18/39) hastadan elde edilen toplam 155 lezyon çalışmaya dahil edildi. Lezyonların boyutları, DWI ile tespit edilen lezyonların görünümü, minimum ADC (ADCmin) değerleri ve ortalama ADC (ADCav) değerleri, b= 0 ve b = 1000 s/mm2 değerleri kullanılarak 1,5 Tesla MRG ile değerlendirildi. Tanımlanan parametreler açısından metastazlar ve HCC arasındaki farklar araştırıldı. Ayrıca metastazları HCC'den ayırmada ADCmin ve ADCav parametrelerinin performansını değerlendirmek için ROC analizi kullanıldı. Bulgular: Lezyonların 131'i metastaz, 24'ü HCC idi. Hedef işareti olarak tanımlanan, DWI'da merkezi hipointens, periferik hiperintens izlenen imaj DWI ile 72 metastatik lezyonda (%55) ve 6 HCC lezyonunda (%25) saptandı ve metastatik grupta hedef işareti saptanma oranı HCC'ye göre daha yüksekti (p<0,007). Ayrıca HCC grubunda, ADCmin ve ADCav değerleri metastatik gruba göre daha yüksek bulundu (p<0.001). ROC analizine dayalı olarak, metastazı HCC'den ayırmada optimal ADCmin ve ADCav değerleri sırasıyla <758 x10-6 ve <817x10-6 mm2/s idi (Duyarlılık: 0.412, 0.412; Özgüllük: sırasıyla 0.875, 0.917). Sonuç: DWI ve ADC değerleri ile saptanan hedef işareti, metastaz ve HCC ayrımında tanısal doğruluğu artıran MRI belirteçleri olarak kullanılabilir.

Anahtar Kelimeler

• Hedef İşareti
• Difüzyon Ağırlıklı Manyetik Rezonans Görüntüleme;
• metastaz;
• Hepatosellüler karsinom

Diagnostic Value of Target Sign and Apparent Diffusion Coefficient Measurements in the Differentiation between Hepatocelular Carcinoma and Liver Metastasis on Diffusion Weighted Magnetic Resonance Imaging

Öz

Objective: The aim of our study is to investigate probable differences between the incidence of target sign detected by diffusion-weighted magnetic resonance imaging (DWI) and apparent diffusion coefficient (ADC) values between metastases and hepatocellular carcinomas (HCC). Materials and Methods: A total of 155 lesions obtained from 57 (female/male: 18/39) patients were included in the study. Dimensions of lesions, the appearance of lesions detected by DWI, minimum ADC (ADCmin) values, and average ADC (ADCav) values were evaluated with 1.5 Tesla MRI using b= 0 and b = 1000 s/mm2 values. Differences between metastases and HCC were investigated in terms of defined parameters. Also, ROC (receiver operating curve) analysis was used to evaluate the performance of ADCmin and ADCav parameters in distinguishing metastases from HCC. Results: Of the lesions, 131 were metastases, while 24 were HCC. The image showing centrally hypointense, periphery hyperintense signal in DWI defined as target sign. Target sign detected in 72 metastatic lesions (55%) and 6 HCC lesions (25%) with DWI, and the rate of target sign detection was higher in the metastatic group compared with HCC (p<0.007). Also, ADCmin and ADCav values were found to be higher in the HCC group compared with the metastatic group (p<0.001). Based on ROC analysis optimal ADCmin and ADCav values were <758 x10-6 and <817x10-6 mm2/s, respectively, in distinguishing metastasis from HCC (Sensitivity: 0.412, 0.412; Specificity: 0.875, 0.917 respectively). Conclusion: Target sign detected by DWI and ADC values can be used as MRI markers that enhance diagnostic accuracy in distinguishing between metastases and HCC.

Anahtar Kelimeler

• Target Sign;
• Diffusion-Weighted Magnetic Resonance Imaging;
• Metastasis;
• Hepatocellular Carcinoma

Kaynakça

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