Talasemi Hastalarında Karaciğer Demir Ölçümünde T2*-ADC Karşılaştırması

Öz

Amaç: Talasemi, hastalarında tekrarlayıcı transfüzyon bir tedavi opsiyonudur, fakat bu durum başta karaciğer olmak üzere değişik organlarda demir birikimine neden olmaktadır. Bu çalışmada talasemi hastalarında, serum ferritin konsantrasyonları ile karaciğer T2* MR ölçümleri ve ADC değerlerinin korelasyonu konusundaki kendi deneyimimizin sunulması amaçlanmıştır. Gereç ve yöntem: Beta talasemi nedeni ile karaciğere yönelik T2* MR tetkiki yapılan ardışık 74 olgu çalışmaya dahil edilmiştir. Olguların karaciğer T2* ve ADC ölçümleri ile ferritin ölçümleri karşılaştırıldı. MR incelemesi 3T tarayıcı ile yapıldı. T2* MR incelemelerinde multieko gradyan eko kullanıldı. Karaciğer sol lob medial ve lateral segmentten birer ve sağ lob anterior ve posterior segmentlerden birer adet olmak üzere toplam 4 farklı bölgeden T2* ve ADC ölçümleri yapıldı. Serum ferritin düzeyleri ile R2* ve ADC ölçümleri arasındaki korelasyonu değerlendirmek için Spearman korelasyon analizi yapıldı. Bulgular: Hastaların 32’si (%43,24) kadın, 42’si (%56,76) erkekti. Serum ferritin ile karaciğer T2* ölçümleri arasında orta düzeyde negatif bir korelasyon vardı (r= -0,52 p<0,01). En yüksek T2* değeri 7,85 ms ile karaciğerin sol lob medial segmentinde, en düşük T2* değeri ise 6,5 ms ile karaciğerin sağ lob arka segmentinde ölçüldü. Serum ferritini ile ADC arasında negatif zayıf bir korelasyon vardı (r= -0.41, p<0.01). En yüksek ADC değeri 908,90 mm2/s ile karaciğerin sol lob medial segmentinde, en düşük ADC değeri ise 766,78 ile karaciğerin sağ lob ön segmentinde ölçüldü. Karaciğer T2* ölçümleri ile ADC ölçümleri arasında orta-yüksek korelasyon mevcuttu. Bu korelasyon serum ferritin ile karaciğer T2* ölçümleri arasındaki korelasyondan daha yüksekti. Sonuç: Serum ferritin ölçümleri ile hem ADC hem de T2* ölçümleri arasındaki korelasyonlar literatürde 1,5T ile bulunanlardan daha düşüktür. ADC’nin serum ferritin ile korelasyonu, serum ferritin ve T2*MR arasındaki korelasyondan daha düşük olduğundan, talasemi hastalarında karaciğer demir birikiminin değerlendirilmesinde ADC’nin T2* ölçümleri kadar yararlı olduğunu düşünmüyoruz.

Anahtar Kelimeler

• T2* MRI
• ADC
• demir yüklü karaciğer

T2*-ADC Comparison in Liver Iron Quantification in Thalassemia Patients

Öz

Objective: Repetitive transfusion is a treatment option in patients with thalassemia, but this causes iron accumulation in various organs, especially the liver. In this study, it is aimed to present our own experience in the correlation of serum ferritin concentrations with liver T2* MR measurements and ADC values in thalassemia patients. Materials and methods: Seventy-four consecutive patients who underwent T2* MR examination of the liver due to beta thalassemia were included in the study. Liver T2* and ADC measurements and ferritin measurements of the patients included in the study were compared. MRI examination was performed with 3T scanner. Multiecho gradient echo was used for T2* MRI examinations. T2* and ADC measurements were made from 4 different regions of the liver, one each from the medial and lateral segments of the left lobe and one each from the anterior and posterior segments of the right lobe. Spaerman correlation analysis was performed to evaluate the correlation between serum ferritin levels and R2* and ADC measurements. Results: Thirty-two patients (43.24%) were female and and forty-two (56.76%) were male. There was moderate correlation between serum ferritin and liver T2* measurements (r= -0.52 p<0.01). The highest T2 value was measured in the left lobe medial segment of the liver as 7.85 ms and the lowest was measured in the right lobe posterior segment of the liver as 6.5 ms. There was weak correlation between serum ferritin and ADC (r= -0.41, p<0.01). The highest ADC value was measured in the left lobe medial segment of the liver as 908.90 mm2/s and the lowest was measured in the right lobe anterior segment of the liver as 766.78. There was a moderate-high correlation between liver T2* measurements and ADC measurements. This correlation was higher than the correlation between serum ferritin and liver T2* measurements. Conclusion: Correlations between the serum ferritin measurements and both ADC and T2* measurements are lower than those found with 1.5T in the literature. The correlation of ADC with serum ferritin is lower than the correlation between serum ferritin and T2*MR, so we do not think ADC is as useful as T2* measurements in assessing liver iron accumulationin in thalassemia patients.

Anahtar Kelimeler

• T2* MRI
• ADC
• İron loaded liver

Kaynakça

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