Kistik Fibrozis Hastalarında Akciğer Tutulumunun Manyetik Rezonans Görüntüleme ile Değerlendirilmesi

Öz

Amaç: Kistik Fibrozis (KF) hastalığında pulmoner yapısal değişikliklerin erken dönemde noninvaziv olarak gösterilmesi ile tedaviye daha erken başlanarak ve mevcut tedavi gözden geçirilerek komplikasyonların önüne geçilebilir. Erken dönem pulmoner yapısal değişiklikleri, pulmoner alevlenme öncesi ve sonrası tedavi yanıtını göstermede bilgisayarlı toraks tomografisi (BT) ile beraber mediastinal manyetik rezonans görüntüleme (MRG) kullanılmaya başlanmıştır. Bu çalışmanın amacı, kliniğimizde KF ile takip edilen ve kliniği stabil hastalarda eş zamanlı olarak toraks BT ve MRG çekilen hastalardaki radyolojik bulguların birbirleri ile karşılaştırılması ve hastaların bazı klinik ve laboratuar bulguları ile korelasyon yapılarak; takiplerinde uygun yöntemle görüntüleme yapmaktır.

Gereç ve Yöntemler: Ağustos 2018 - Şubat 2019 tarihleri arasında, hastanemiz Çocuk Göğüs Hastalıkları Kliniği’nde KF tanısı ile takip edilmekte olan, klinik olarak stabil 14 hastanın aynı gün çekilen BT ve MRG’leri geriye dönük olarak Helbich ve Eichinger skorlama sistemine göre incelendi. Hastaların demografik verileri, klinik ve laboratuar bulguları kronik kolonizasyon durumu ve genetik mutasyonları kaydedildi.

Bulgular: KF tanısı ile takip edilmekte olan, pulmoner alevlenme şikayeti olmayan 14 hastanın aynı gün çekilen BT ve MRG’leri geriye dönük olarak değerlendirildi. BT ve MRG bulguları karşılaştırıldığında Helbich skorlama sistemine göre sadece mozaik atenüasyon paterninde BT ile daha iyi tanımlandığı gösterildi (p = 0.003). Helbich skorlama sistemine göre BT için ortalama skor 6.6 (1-17), MRG için 4.7 (0-15)’di. Eichinger skorlamasına göre MRG için ortalama skor 3 (0-16)’dı.Hastaların klinik ve demografik bulguları karşılaştırıldığında Phe508del homozigot mutasyonu olup P.aeruginosa ile kronik kolonize olan hastaların BT ve MRG skorları diğer hastalara göre anlamlı olarak daha yüksekti (p = 0.002).

Sonuç: KF hastalarında pulmoner etkilenmeyi göstermek için mediastinal MRG toraks BT kadar güvenilir; radyasyon içermediği için de tercih edilebilir bir yöntemdir. Mozaik atenüasyon gibi erken dönem akciğer bulgularının değerlendirilmesinde ise BT ile beraber kullanılabilir. Yakın zamanda KF hastalarındaki akciğer bulgularını göstermede deneyimli personel ve yeni çekim teknikleri ile MRG altın standart haline gelebilir.

Anahtar Kelimeler

• Kistik fibrozis
• bilgisayarlı tomografi
• manyetik rezonans görüntüleme
• pulmoner tutulum

The Evaluation of Lung Involvement in Patients with Cystic Fibrosis By Using Mediastinal Magnetic Resonance Imaging

Öz

Objective: In Cystic Fibrosis (CF) disease, complications can be avoided by noninvasively demonstrating pulmonary structural changes in the early period by starting treatment earlier and reviewing the current treatment. Computed thoracic tomography (CT) and mediastinal magnetic resonance imaging (MRI) have been used to show early pulmonary structural changes and treatment response before and after pulmonary exacerbation.The aim of this study is to compare the CT and MRI findings of CF patients with some clinical and laboratory findings, and to perform imaging with an appropriate method in their follow-up.

Material and Methods: CT and MRIs of 14 clinically stable CF patients August 2018 and February 2019 were retrospectively analyzed according to the Helbich and Eichinger scoring system. Patient’s laboratory findings, chronic colonization status and genetic mutations were recorded.

Results: According to Helbich scoring, the mean score in CT was 6.6 (score range 1-17), while MRI was 4.7 (score range 0-15). The mean score in the MRI was 3 (score range 0-16) according to the Eichinger score. There was a statistically significant difference between CT and MRI findings according to Helbich scoring (p=0.003). CT was superior to MRI in demonstrating mosaic attenuation. Four patients who had Phe508del homozygous mutation chronic colonised with p.aeruginosa and had higher CT and MRI scores than rest of them (p=0.002).

Conclusion: Mediastinal MRI is as reliable as thoracic CT; to show pulmonary involvement in CF patients and can be preferred to reduce radiation damage. MRI can be used together with CT in the evaluation of early lung findings such as mosaic attenuation. Recently, MRI may become the gold standard with experienced staff and new imaging techniques in demonstrating lung findings in CF patients.

Anahtar Kelimeler

• Cystic Fibrosis
• Computed Tomography
• Magnetic Resonance İmaging
• Lung İnvolvement

Kaynakça

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