Fokal renal lezyonlarının benign ve malign ayırımında manyetik rezonans difüzyon tensör görüntülemenin rolü
Öz
Amaç: Fokal böbrek lezyonlarının benign, malign ayırımında
görünüşteki difüzyon katsayısı (apparent diffusion coefficient
- ADC) ve fraksiyonel anizotropi (Fa) ölçümlerinin diagnostik
performanslarının belirlenmesi.
Gereç ve Yöntem: Çalışmamıza, bilgisayarlı tomografi (BT)
ve ultrason (US) gibi değişik görüntüleme modaliteleri ile tanı
konulan ve manyetik rezonans diffüzyon tensör görüntülemesi
(DTI) yapılmış 21 hastada (9 kadın and 12 erkek ; ortalama yaş
54,1 ), 25 fokal renal lezyon dahil edildi. Lezyonlar 6 solid renal
hücreli karsinom (RCC), 1 kistik RCC, 1 anjiomyolipom (AML)
ve 17 kistik lezyondan ( 16 Bosniak tip I kist, 1 Bosniak tip II
kist) oluşmaktaydı. ADC ve Fa ölçümleri iki radyolog tarafından,
konsensusa varılarak yapıldı. Malign ve benign lezyonlara ait
ADC ve Fa değerleri ANOVA ve Tukey testleri kullanılarak
karşılaştırıldı. ROC analizi kullanıldı; sensitivite ve spesifite
hesaplandı.
Bulgular: Malign lezyonların ortalama ADC ve Fa değerleri
sırasıyla 1.29±0.4 mm2/sn ve 0.34±0.1 ölçüldü. Benign lezyonların
ortalama ADC ve Fa değerleri sırasıyla 2.6±0.7 mm2/sn ve
0.19±0.12 ölçüldü. Aralarındaki fark istatistiksel olarak anlamlı idi
(P<0.05). Malign lezyonları, benign lezyonlardan ayırmada ADC
ve Fa ölçümlerinin, Az değerleri sırasıyla 0.95 ve 0.83 bulundu.
ADC ve Fa ölçümlerinin sensitivite ve spesifite değerleri sırasıyla
100%-83.3% ve 100%-77.8% bulundu.
Sonuç: Malign ve benign fokal renal lezyonların ADC ve Fa
ölçümleri değerleri arasında istatistiksel anlamlı farklar mevcuttur.
Malign renal lezyonlarda düşük ADC ve yüksek Fa değerleri
izlenirken, benign renal lezyonlarda yüksek ADC ve düşük Fa
değerleri izlenir.
Anahtar Kelimeler
Kaynakça
- Le Bihan D, Breton E, Lallemand D, Aubin ML, Vignaud J, Laval-Jeantet M. Separation of diffusion and perfusion in intravoxel incoherent motion MR imaging. Radiology 1988;168:497-505. doi: 10.1148/radiology.168.2.3393671
- Bonekamp S, Torbenson MS, Kamel IR. Diffusion-weighted magnetic resonance imaging for the staging of liver fibrosis. J Clin Gastroenterol 2011;45:885-92. doi: 10.1097/ MCG.0b013e318223bd2c
- Sugita R, Ito K, Fujita N, Takahashi S. Diffusion-weighted MRI in abdominal oncology: Clinical applications. World J Gastroenterol 2010;16:832-6.
- Gurses B, Kabakci N, Kovanlikaya A, et al. Diffusion tensor imaging of the normal prostate at 3 Tesla. Eur Radiol 2008; 18:716–21. doi:10.1007/s00330-007-0795-7
- Le Bihan D, Mangin JF, Poupon C, et al.Diffusion tensor imaging: concepts and applications. J Magn Reson Imaging 2001;13:534–46.
- Gurses B, Tasdelen N, Yencilek F, et al.Diagnostic utility of DTI in prostate cancer. Eur J Radiol 2011; 79:172–6. doi: 10.1016/j.ejrad.2010.01.009
- Kinoshita M, Hashimoto N, Goto T, et al. Fractional anisotropy and tumor cell density of the tumor core show positive correlation in diffusion tensor magnetic resonance imaging of malignant brain tumors. Neuroimage 2008;43:29- 35. doi: 10.1016/j.neuroimage.2008.06.041
- Thoeny HC, De Keyzer F, Oyen RH, Peeters RR. Diffusionweighted MR imaging of kidneys in healthy volunteers and patients with parenchymal diseases: initial experience. Radiology. 2005;235:911-7. doi: 10.1148/radiol.2353040554
- Cova M, Squillaci E, Stacul F, et al. Diffusion-weighted MRI in the evaluation of renal lesions: preliminary results. Br J Radiol 2004;77:851-7. doi: 10.1259/bjr/26525081
- Inci E, Hocaoglu E, Aydin S, Cimilli T. Diffusion-weighted magnetic resonance imaging in evaluation of primary solid and cystic renal masses using the Bosniak classification. Eur J Radiol 2012 ;81:815-20. doi : 10.1016/j.ejrad.2011.02.024
- Kim S, Jain M, Harris AB, Lee VS, Babb JS, Sigmund EE, et al. T1 hyperintense renal lesions: characterization with diffusion-weighted MR imaging versus contrast-enhanced MR imaging. Radiology 2009; 251:796-807. doi: 10.1148/ radiol.2513080724
- Notohamiprodjo M, Glaser C, Herrmann KA, et al. Diffusion tensor imaging of the kidney with parallel imaging: initial clinical experience. Invest Radiol 2008; 43:677-85. doi: 10.1097/RLI.0b013e31817d14e6
- Taouli B, Thakur RK, Mannelli L, et al. Renal lesions: characterization with diffusion-weighted imaging versus contrast-enhanced MR imaging. Radiology. 2009;251:398- 407. doi: 10.1148/radiol.2512080880
The role of magnetic resonance diffusion tensor imaging in differentiation of benign from malignant focal renal lesions
Öz
Objectives: To determine the diagnostic performance of apparent
diffusion coefficient (ADC) and fractional anisotropy (Fa)
measurements in differentiation of malignant from benign focal
renal lesions.
Material and Methods: Twenty-one patients (9 women and 12
men ; mean age 54,1 years) with 25 focal renal lesions diagnosed
by different imaging modalities such as computed tomography
(CT) and ultrasound (US) and examined with magnetic resonance
diffusion tensor imaging (DTI) were included in the study. There
were 6 solid renal cell carcinomas (RCC), 1 cystic RCC, 1
angiomyolipoma (AML) and 17 cystic lesions ( 16 Bosniak type
I cysts, 1 Bosniak type II cyst). ADC and Fa measurements were
performed by two radiologists, in consensus. The differences in
ADC and Fa values of malignant and benign renal lesions were
compared using ANOVA and Tukey tests. A ROC analysis was
applied; sensitivities and specificities were calculated.
Results: The mean ADC and Fa values of malignant lesions
were 1.29±0.4 mm2/sec and 0.34±0.1, respectively. The mean
ADC and Fa values of benign lesions were 2.6±0.7 mm2/sec
and 0.19±0.12, respectively. The differences were significant
(P<0.05). The Az values for discriminating malignant lesions from
benign ones for ADC and Fa value were 0.95 and 0.83, respectively. The sensitivity-specificity of ADC and Fa were 100%-83.3%, and
100%-77.8%, respectively.
Conclusion: There are statistically 2l significant differences
between ADC and Fa values of malignant and benign focal renal
lesions. Malignant renal lesions have low ADCs and high Fa
values, whereas benign renal lesions have high ADCs and low Fa
values.
Anahtar Kelimeler
Kaynakça
- Le Bihan D, Breton E, Lallemand D, Aubin ML, Vignaud J, Laval-Jeantet M. Separation of diffusion and perfusion in intravoxel incoherent motion MR imaging. Radiology 1988;168:497-505. doi: 10.1148/radiology.168.2.3393671
- Bonekamp S, Torbenson MS, Kamel IR. Diffusion-weighted magnetic resonance imaging for the staging of liver fibrosis. J Clin Gastroenterol 2011;45:885-92. doi: 10.1097/ MCG.0b013e318223bd2c
- Sugita R, Ito K, Fujita N, Takahashi S. Diffusion-weighted MRI in abdominal oncology: Clinical applications. World J Gastroenterol 2010;16:832-6.
- Gurses B, Kabakci N, Kovanlikaya A, et al. Diffusion tensor imaging of the normal prostate at 3 Tesla. Eur Radiol 2008; 18:716–21. doi:10.1007/s00330-007-0795-7
- Le Bihan D, Mangin JF, Poupon C, et al.Diffusion tensor imaging: concepts and applications. J Magn Reson Imaging 2001;13:534–46.
- Gurses B, Tasdelen N, Yencilek F, et al.Diagnostic utility of DTI in prostate cancer. Eur J Radiol 2011; 79:172–6. doi: 10.1016/j.ejrad.2010.01.009
- Kinoshita M, Hashimoto N, Goto T, et al. Fractional anisotropy and tumor cell density of the tumor core show positive correlation in diffusion tensor magnetic resonance imaging of malignant brain tumors. Neuroimage 2008;43:29- 35. doi: 10.1016/j.neuroimage.2008.06.041
- Thoeny HC, De Keyzer F, Oyen RH, Peeters RR. Diffusionweighted MR imaging of kidneys in healthy volunteers and patients with parenchymal diseases: initial experience. Radiology. 2005;235:911-7. doi: 10.1148/radiol.2353040554
- Cova M, Squillaci E, Stacul F, et al. Diffusion-weighted MRI in the evaluation of renal lesions: preliminary results. Br J Radiol 2004;77:851-7. doi: 10.1259/bjr/26525081
- Inci E, Hocaoglu E, Aydin S, Cimilli T. Diffusion-weighted magnetic resonance imaging in evaluation of primary solid and cystic renal masses using the Bosniak classification. Eur J Radiol 2012 ;81:815-20. doi : 10.1016/j.ejrad.2011.02.024
- Kim S, Jain M, Harris AB, Lee VS, Babb JS, Sigmund EE, et al. T1 hyperintense renal lesions: characterization with diffusion-weighted MR imaging versus contrast-enhanced MR imaging. Radiology 2009; 251:796-807. doi: 10.1148/ radiol.2513080724
- Notohamiprodjo M, Glaser C, Herrmann KA, et al. Diffusion tensor imaging of the kidney with parallel imaging: initial clinical experience. Invest Radiol 2008; 43:677-85. doi: 10.1097/RLI.0b013e31817d14e6
- Taouli B, Thakur RK, Mannelli L, et al. Renal lesions: characterization with diffusion-weighted imaging versus contrast-enhanced MR imaging. Radiology. 2009;251:398- 407. doi: 10.1148/radiol.2512080880
Ayrıntılar
| Konular | Klinik Tıp Bilimleri |
|---|---|
| Bölüm | Makaleler |
| Yazarlar | |
| Yayımlanma Tarihi | 14 Mayıs 2017 |
| Yayımlandığı Sayı | Yıl 2017 Cilt: 30 Sayı: 2 |