Bilgisayarlı Toraks Tomografisinde Sternal Metastaz Olarak Değerlendirilen Lezyonların Hastaların Primer Maligniteleri ile Korelasyonu

Öz

Sternal metastazları BT özelliklerine göre değerlendirmek ve hastaların primer maligniteleriyle ilişkilendirmekti. Çalışma Tasarımı: Metastazların yeri sternal anatomiye göre gruplandırıldı. Sternum ve diğer sternum olmayan kemiklerdeki metastazlar litik, sklerotik ve karışık olarak sınıflandırıldı. Sternal metastazlar primer malignitelerine göre gruplandırıldı. Yöntemler: Sternal metastazlarda maksimum standart alım değeri (SUVmax) PET-CT'de ölçüldü. Sternum metastazları tespit edildiğinde akciğer parankiminde metastaz varlığı değerlendirildi. Çalışmadan elde edilen veriler bir bilgisayara aktarılmış ve istatistiksel paket değeri (SPSS sürüm 15.0) kullanılarak p≤0.05 istatistiksel anlamlılık değerinde değerlendirilmiştir. Bulgular: 69 hasta arasında birincil tanı% 29.0 (n = 20) akciğer kanseri,% 27.5 (n = 19) prostat kanseri ve% 21.7 (n = 15) meme kanseri idi. Sternum lokalizasyonunda BT görüntülemesinde% 89.8 (n = 62) 'te korpus tutulumu,% 57.9' da manubrium tutulumu (n = 40) ve% 11.6 (n = 8) 'de ksifoid tutulumu saptandı. Maksimum lezyon yoğunluğu 26 ila 974 HU arasında değişmekteydi ve ortalama 352 HU idi. Maksimum lezyon çapı, eksenel kesitte 3,0 ila 32,1 mm arasındaydı ve ortalama 11,61 mm idi. En sık görülen metastaz tipi sternumda sklerotik (% 60.9) ve sternum dışı kemiklerde multipl sklerotik (% 50.7) idi. Hastaların% 15.9'unda (n = 11) hem sternumda hem de akciğer parankiminde metastaz mevcuttu. En sık görülen korpus sternum tutulumu akciğer kanserinde, manubrium ve ksifoid tutulumu en çok prostat kanserinde görülmüştür. Sklerotik metastaz tutulumu prostat kanserinde de en sık görülmüştür. Lezyon yoğunluğu prostat kanserinde diğer kanser türlerine göre daha yüksekti. Aksiyal kesitteki lezyonların çapı veya ölçülen SUVmax değerleri açısından kanser türleri arasında fark bulunmadı. Sonuçlar: BT sternum metastazlarının saptanmasında önemli bir tanı aracıdır ve PET-BT ile korelasyon göstermelidir. Özellikle akciğer kanserlerinde düşük SUVmax değerlerinin elde edilebileceği unutulmamalıdır. Primer maligniteler arasında akciğer kanseri ve prostat kanserlerinde manubrium ve ksifoid metastazlarda en sık korpus sternum metastazı saptandı. Ayrıca, korpus sternum tutulumunun en yaygın lokalizasyon olduğu saptanmıştır, bu da özellikle korpus sternumun metastazların taranmasında dikkatle değerlendirilmesi gerektiğini göstermektedir.

Anahtar Kelimeler

• Sternum,Metastaz,bilgisayarlı tomografi,Pozitron Emisyon Tomografisi,Toraks

Correlation of Lesions Evaluated as Sternal Metastases on the Computed Tomography of the Thorax with Primary Malignancies of Patients

Abstract

Our aim was to evaluate sternal metastases according to the CT characteristics and correlate them with the primary malignancies of patients. The location of metastases was grouped according to sternal anatomy. The metastases in the sternum and other non-sternum bones were classified as lytic, sclerotic, and mixed. Sternal metastases were grouped according to their primary malignancy. For sternal metastases, the maximum standard uptake value (SUVmax) was measured on PET-CT. The presence of metastases in the lung parenchyma was evaluated when sternum metastases were detected. The data obtained from the study were transferred to a computer and evaluated using a statistical package program (SPSS version 15.0) at a statistical significance value of p≤0.05. Among the 69 patients, the primary diagnosis was lung cancer in 29.0% (n=20), prostate cancer in 27.5% (n=19), and breast cancer in 21.7% (n=15). In the sternum localization, the CT imaging revealed corpus involvement in 89.8% (n=62), manubrium involvement in 57.9% (n=40), and xiphoid involvement in 11.6% (n=8). The maximum lesion density ranged from 26 to 974 HU with a median of 352 HU. The maximum lesion diameter ranged from 3.0 to 32.1 mm in the axial section, with a median of 11.61 mm. The most common type of metastasis was sclerotic (60.9%) in the sternum and was multiple sclerotic (50.7%) in non-sternum bones. Of the patients, 15.9% (n=11) had metastasis both in the sternum and lung parenchyma. The most common corpus sternum involvement was found in lung cancer, while manubrium and xiphoid involvement was most observed in prostate cancer. Sclerotic metastasis involvement was also most frequent in prostate cancer. Lesion density was higher in prostate cancer than other types of cancer. No difference was found between the types of cancer in terms of the diameter of lesions in the axial section or the measured SUVmax values. CT is an important diagnostic tool in the detection of sternum metastases and should be correlated with PET-CT. It should be kept in mind that low SUVmax values can be obtained, especially in lung cancers. Among primary malignancies, corpus sternum metastasis was most common in lung cancers and manubrium and xiphoid metastases in prostate cancers. Furthermore, corpus sternum involvement was found to be the most common localization, indicating that especially the corpus sternum should be carefully evaluated in the scanning of metastases.

Keywords

• Sternum,Metastasis,Computed Tomography,Positron Emission Tomography,Thorax

Kaynakça

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