Meme kitlelerinde MR-spektroskopi'nin tanıya katkısı
Contribution of MR-spectroscopy in evaluation of breast masses
- Tez No: 142199
- Danışmanlar: PROF. DR. PINAR BALCI
- Tez Türü: Tıpta Uzmanlık
- Konular: Radyoloji ve Nükleer Tıp, Radiology and Nuclear Medicine
- Anahtar Kelimeler: Belirtilmemiş.
- Yıl: 2004
- Dil: Türkçe
- Üniversite: Dokuz Eylül Üniversitesi
- Enstitü: Tıp Fakültesi
- Ana Bilim Dalı: Radyoloji Ana Bilim Dalı
- Bilim Dalı: Belirtilmemiş.
- Sayfa Sayısı: 63
Özet
7. ÖZET Giriş: Meme kanseri tüm dünyada kadınlarda en sık görülen tümördür ve en önde gelen ölüm nedenlerinden birisidir. MR spektroskopi tümör ve normal dokularda metabolik farklılıkları demonstre edebilmektedir. Bu araştırmanın birinci amacı mammografide saptanan meme kitlelerinde benign ve malign ayrımı net olarak yapılamayan lezyonlarda MR görüntüleme ile lezyonların karakteristiğini saptamak ve ek sekans olarak lokalize hidrojen -1 MR spektroskopi yöntemi ile total kolin seviyesini temel alarak klinik yararlığını araştırmaktır. İkinci amaç ise malign olgularda histopatolojik derece ile kolin/lipid oranı arasındaki korelasyonu ve klinik yaralılığı saptamaktır. Gereç ve Yöntem: Bu çalışmaya Dokuz Eylül Üniversitesi Tıp Fakültesi Radyodiagnostik Anabilim Dalı Mammografı Ünitesine fizik muayenede memede kitle ön tanısı ile başvuran, yaşları 18-74 arasında (ortalama 42.7) 44 gönüllü olgu (43 kadın, 1 erkek) dahil edildi. Öncelikle 44 olgunun 12 tanesine ultrasonografi, 32 tanesine mammografi ve ultrasonografi incelemesi uygulandı. MR incelemesi olguların tümüne 1.5 Tesla MR tüm vücut görüntüleme cihazında (Philips Gyroscan Intera, Release 8, Philips Turkey) yapıldı. 1H MRS incelemesi tüm olgularda MR mammografi incelemesinde üç planda (aksiyal, sagital, koronal) tespit edilen lezyona yönelik uygulandı. Tek- voksel *H MRS incelemesinde point-resolved spectroskopi sekansı (PRESS) (TR=2000 ms, TE=136 ms, ilgili hacim (VOI) ortalama=4096 mm3, aralık=5 07-8000 mm3) kullanıldı. MR spektroskopi incelemesinin toplam süresi yaklaşık 10 dakika idi. MRS' de kolin piki varlığının meme lezy onlarında malign ve benign ayrımındaki tanısal etkinliği, gerçek-pozitif, gerçek negatif, yalancı pozitif ve yalancı-negatif oranları,seçicilik, duyarlılık,pozitif prediktif değer (PPD) ve tutarlılığı saptandı. Benign ve malign grupta kolin piki varlığı Ki-Kare Testi ile analiz edildi. Kolin/lipid oranının histopatolojik derecelendirmede klinik kullanabilirliğini değerlendirebilmek amacıyla bu ölçütler Mann-Withney U, Spearman Correlations testi ve ROC eğrisi analizi ile değerlendirildi. 49
Özet (Çeviri)
SUMMARY Purpose: Determination of choline levels by (Hydrogen 1) magnetic resonance spectroscopy (1H MRS) has been recently used to differentiate between benign and malign breast masses.Although it seems to be quite a sensitive and specific tool, more data are needed to confirm its efficacy. The first aim is to determine the value of choline level in differentiation of benign and malign breast lesions. The second aim is to check if there is a correlation between histopathologic grading and choline - fat ratios. In a seventeen-month period all patients referred for radiological evaluation of a breast mass were included in the study. The MR spectroscopic results were compared with histopathologic and surgical information. Based on the choline levels detected by XH MRS, the mass lesions were diagnosed as either malign or benign. The choline -fat ratios were compared with histopathologic grading in malign lesions. Materials and Methods: 44 patients (43 female, 1 male) with 44 breast masses (18 palpable, 26 non palpable) were included in this prospective study. The mean age was 42 years and the range was 18-74 years. All patients presented with a breast mass were confirmed by the referring surgeon. The mean lesion size was 2.5 cm (range 1.8-6 cm). The lesions to be studied were detected with US and/or mammography. Of the 44 patients 12 underwent only ultrasonography while 32 patients (24 masses were supposed to be malign) were examined by both ultrasonography and mammography.Magnetic resonance (MR) mammography and 1H MRS were done in all patients. MR examinations were done with a 1.5 T whole body MR imaging system (Philips Gyroscan Intera, Release 8, Philips Turkey) with the use of standard breast coils or superficial coils. MR mammography included sagittal and axial turbo spin echo (TSE) T2 weighted images with spectral presaturation with inversion recovery for fat saturation (TR=4220 ms, TE=120 ms, thickness=3 mm, FOV=300 mm, turbo factor=19, number of excitations (NEX)=2, acquisition time=2.55 min), axial Tl weighted images with spectral presaturation with inversion recovery for fat saturation (TR=550 ms, TE=11, thickness=3 mm, FOV=300 mm, turbo factor=5, 52NEX=2, acquisition time=3.07 min), axial pre- and dynamic post-gadolinium 3 dimensional (3D) gradient echo Tl weighted images (TR=12 ms, TE=4 ms, thickness=4 mm, FOV=320 mm, flip angle=20°, NEX=1, acquisition time= 4.08 min) and finally post gadolinium 3D gradient echo Tl weighted (TR=15 ms, TE=5 ms, thickness=3 mm, FOV= 350 mm, flip angle=30°, acquisition time=2.40 min) images. For the contrast enhanced images gadodiamid was given by intravenous route at a dose 0.2 mmol per kilogram body weight. 'H MRS was performed once for every lesion. When the patient had more than one lesions, the largest one was sampled for 1H MRS. Single voxel 1H MRS was done by employing the point-resolved spectroscopic sequence (PRESS) (TR=2000 ms, TE=136 ms, volume of interest, mean=4096 mm3, range: 507-8000 mm3). By using the PRESS sequence, water-suppressed spectra were acquired for each volume of interest 5 minutes after administration of contrast material for MR imaging. The volume of interest was carefully positioned within the enhancing breast lesions. Automated parameter optimisation consisted of frequency and receiver gain adjustment, shimming, and gradient tuning. Water suppression was achieved with selective inversion recovery, starting the measurement at the zero crossing of the water signal. Data were acquired at spectral bandwidth of 1000Hz. The time required to complete the MR spectroscopic examinations was approximately 10 minutes. All MR spectra were analysed. The resonance frequency and line width of choline were selected automatically; these values were used as prior knowledge input in fitting process. The criterion used to determine whether or not choline was present at 3.2 ppm should be clearly identifiable at TEs 136 msec. The presence of a choline peak was interpreted as an evidence for malignancy whereas its absence was regarded in favor of benign process. True- positive, true negative, false positive and false-negative detection rates, as well as sensitivity and specificity, were determined.The mean choline concentration in the benign and malign groups were analysed by using Chi-Square Tests. Choline -fat ratios were calculated for every case where a choline peak was present. The mean choline-fat ratio was analysed by using ROC analysis and Spearman Correlation test. 53Results: 19 patients had carcinomas (12 cases BIRADS IV, 7 cases BIRADS V) of breast diagnosed histopathologically, includinglO infiltrating ductal carcinoma (pathology: 4 grade II, 6 grade III), 8 invasive lobular carcinomas (pathology: 3 grade II, 5 grade III), and 1 inflammatory carsinoma (pathology: grade III). 25 patients22 had fibroadenoma, 1 lipoma and one had a complicated simple cyst. This mass measured 1.8 cm in longest diameter, which makes it difficult to place an optimal size volume of interest Based on the spectroscopic data, in 17 of 19 carcinoma cases, elevated choline levels were detected. In 2 patients with carcinoma (one of them smaller than 2 cm, one of them had metallic artefact) and 25 patients having benign lesions, choline levels were within normal range. The sensitivity and specificity of 1H MRS for detecting breast cancer were 89% and 100% (p
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