Prostat Kanseri Tanı ve Lokal İnvazyon Değerlendirmesinde Multiparametrik Manyetik Rezonans Görüntülemenin Önemi

Yıl 2021, Cilt: 28 Sayı: 1, 73 - 83, 11.03.2021

Hüseyin Aydın Mustafa Balcı

https://doi.org/10.17343/sdutfd.811682

Öz

Amaç: Prostat kanseri (PCa) tanısı ve kanser dışı prostat hastalıklarından (KDPH) ayırımında multiparametrik manyetik rezonans görüntülemenin (mpMRG) önemi değerlendirilmiştir.
Materyal Metod: Aralık 2017 ile Ocak 2020 tarihleri arasında, prostat kanseri (PCa) ön tanısı ile mpMRG yapılan 99 hastanın görüntüleri retrospektif olarak değerlendirildi. Standart MpMRG çekim protokolü T2A TSE (aksiyel-koronal-sagital), T1A TSE (axial-koronal-sagital), difüzyon ağırlıklı görüntüleme (DAG) ve T1A dinamik kontrastlı inceleme (DKİ) sekanslarından oluştu. Lezyonların lokasyonu, morfolojisi, ekstraprostatik yayılımı (EPY), T2A sinyal intensite (T2SI) değerleri, difüzyon kısıtlılığı, kontrastlanma eğri paternleri, maksimum kontrastlanma değeri (Cmax), maksimum kontrastlanmaya ulaşması için geçen süre (akselerasyon zaman: AZ) değerlendirildi. Bulgular arasındaki ilişki SPSS 20.0 programı ile değerlendirildi.
Bulgular: Değerlendirilen 99 olgunun 75’inin Prostat Ca (PCa), 24’ünün KDPH histopatolojik tanısı vardı. Tüm hastaların yaş ortalaması 66.5±7.4 idi. Periferal zon yerleşimli lezyonlarda “apparent diffusion coefficient” (ADC) (p<0,001), Cmax ve AZ (p<0.005) değerleri, PCa ve KDPH grupları arasında anlamlı farklılık saptandı. Transizyonel zon yerleşimli lezyon T2SI değerleri, hasta grupları arasında anlamlı farklılık gösterdi (p<0.001). PCa için Tip1 eğri ve KDPH için Tip 3 eğri paterni, ayırıcı tanı açısından anlamlı (p<0,002) bulundu. Tranzisyonel zon yerleşimli lezyonlarda eğri tipi malign tarafa kaydıkça T2SI’nde azalma görüldü. EPY derecesi arttıkça yakın invazyon oranlarında da artış saptandı (p<0,001).
Sonuç: Multiparametrik prostat MRG, PCa’yı KDPD’dan ayırmada ve lokal invazyon durumunu ortaya koymada son derece değerli bir radyolojik tanı yöntemidir. ADC, T2SI ve DCE kantitatif değerleri, benign-malign lezyon tahmininde önemli rol oynamaktadır.

Anahtar Kelimeler

Prostat kanseri, prostatit, multiparametrik MRG, dinamik kontrastlı MR, difüzyon ağırlıklı görüntüleme

Destekleyen Kurum

YOK

Teşekkür

Makalenin hazırlanmasında yaptığı teknik yardımlardan dolayı, Sayın Dr.Öğretim Üyesi Veysel Atilla Ayyıldız’a çok teşekkür ederiz.

Importance of Multiparametric Magnetic Resonance Imaging in Prostate Cancer Diagnosis and Local Invasion Assessment

Öz

Objective: The importance of multiparametric magnetic resonance imaging (mpMRI) in the diagnosis of prostate cancer (PCa) and in its differentiation from non-cancerous prostate diseases (NCPD) was evaluated.
Material Method: Images of 99 patients who underwent mpMRI with a pre-diagnosis of PCa between December 2017 and January 2020 were retrospectively evaluated. The MpMRG acquisition protocol consisted of T2W TSE (axial-coronal-sagittal), T1W TSE (axial-coronal-sagittal), diffusion-weighted imaging (DWI) and T1W dynamic contrast imaging (DCI) sequences. The location, morphology, extraprostatic spread (EPY) of the lesions, T2W signal intensity (T2SI) values, diffusion restriction, enhancement curve patterns, maximum enhancement value (Cmax), time to reach maximum enhancement (acceleration time: AZ) were evaluated. The relationship between the findings was evaluated using the SPSS 20.0 program.
Results: 75 of 99 cases were diagnosed as Prostate Ca (PCa), 24 of them had NCPD hitopathological diagnosis. The age ratio of all patients was 66.5 ± 7.4. A significant difference was found between the apparent diffusion coefficient (ADC) (p <0.001), Cmax and AT (p <0.005) values, PCa and KDPH groups in lesions located in the peripheral zone. T2SI values of lesions in the transitional zone differed significantly between patient groups (p <0.001). The Type 1 curve for PCa and the Type 3 curve for NCPD were found to be significant in terms of differential diagnosis (p <0.002). In transitional zone lesions, T2SI decreased as the curve type shifted to the malignant side. As the degree of EPY increased, an increase was found in the near invasion rates (p <0.001).
Conclusion: Multiparametric prostate MRI is an extremely valuable radiological diagnostic method in distinguishing PCa from NCPD and revealing the local invasion status. ADC, T2SI and DCE quantitative values play an important role in the prediction of benign-malignant lesions.

Anahtar Kelimeler

Prostate cancer, prostatitis, multiparametric MRI, dynamic contrast MRI, diffusion weighted imaging

Kaynakça

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