Tedavi almamış akciğer kanserli olgularda pozitron emisyon tomografi - bilgisayarlı tomografi ve difüzyon manyetik rezonans görüntülemenin evreleme ve alt tip tayinindeki yeri, retrospektif gözlemsel çalışma
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Dosyalar
Tarih
2020
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Akciğer kanseri en sık ve mortalite oranı en yüksek kanserlerden biridir. Akciğer kanseri şüphesiyle değerlendirilen hastalar için positron emisyon tomografi - bilgisayarlı tomografi (PET-BT) incelemesi rutin olarak yapılmaktadır. Ancak bu tetkikin; işlem öncesi hazırlık, radyasyon alma, çekim süresi ve sonrası bekleme gibi dezavantajları mevcuttur. Difüzyon manyetik rezonans görüntüleme (D-MRG) ise, daha çok kraniyal lezyonların görüntülemesinde kullanılmakla birlikte, diğer organları göstermede kullanılabilecek, apperent diffusion coefficient (ADC) ile semikantitatif ölçümler yapmaya olanak sağlayan, radyasyon içermeyen bir yöntemdir. Akciğer kanserli olguların D-MRG ile tüm vücut değerlendirilmesi, ADC değerleri hesaplanarak mevcut standardized uptake value (SUV) ile karşılaştırılması ve hastaların klinik evrelendirmesinin yapılması amacıyla bu çalışma planlanmıştır. Çalışmaya 4'ü kadın, 46'sı erkek 50 hasta dahil edilmiştir. Ortalama yaş 63.4'tür ve hastaların büyük çoğunluğunda (n=47, %94) sigara öyküsü mevcuttur. PET-BT ve D-MRG ile ayrı ayrı yapılan radyolojik evrelemelerin birbirileri ile aynı olduğu görülmüştür. Hastaların genel olarak değerlendirmesinde SUV ile total ADC/nekrozsuz ADC (nADC) değerleri arasında korelasyon saptanmamıştır (p=0.68, p=0.35). Total lezyon glikolizi (TLG) ile ADC ve nADC arasında da anlamlı bir korelasyon saptanmamıştır (p=0.19, p=0.73). Subgrup analizinde küçük hücreli akciğer karsinomu olgularında SUV ile ADC (p=0.05, r=-0.42), SUV ile nADC (p=0.05, r=-0.35), TLG ile ADC (p=0.01, r=-0.47) ve nekrozsuz ADC arasında orta düzeyde negatif korelasyon saptanmıştır (p=0.03, r=-0.53). Küçük hücreli dışı akciğer karsinomu olgularının alt grup analizinde adenokarsinom olgularında SUV ile ADC/nADC arasında korelasyon saptanmamıştır (p=0.73, p=0.09). TLG ile ADC arasında korelasyon görülmemişken (p=0.16), nADC arasında zayıf negatif korelasyon saptanmıştır (p=0.04, r=- 0.22). Skuamöz hücreli karsinom olgularında ise SUV ile ADC (p=0.02, r=-0.81), SUVmax ile nADC (p=0.04, r=-0.79) güçlü düzeyde negatif korelasyon; TLG ile ADC (p=0.01, r=-0.32) ve nekrozsuz ADC arasında orta düzeyde negatif korelasyon saptanmıştır (p=0.05, r=-0.38). Çalışmamızda difüzyon MRG; akciğer kanserli olgularda tümörün metabolik özelliklerini değerlendirmede, evrelemede PET-BT ile benzer sonuçlar vermiştir. Bu alanda yapılacak yeni çalışmalarla ve gelişen MR teknolojisi ile daha sık kullanılacağına inanılan difüzyon MR'ın akciğer kanseri yönetiminde rutin uygulamaya gireceği umut edilmektedir.
Lung cancer is one of the most common and mortal cancers. Positron emision tomography – computerized tomography (PET-CT) is the most frequently used method in staging though it has some disadventages such as preparation of the patient, radiation exposure, long shooting time and isolated waiting times. On the other hand diffusion magnetic resonans imaging (D-MRI) which is mostly used for imaging of cranial lesions, is a radiation-free method that can be used as whole-body imaging and allows semiquantitative measurements with apperent diffusion coefficient (ADC). In this study, we have planned to assess the lung cancer patients with only the help of whole-body diffusion MRI, in comparison to regular lung cancer staging done with PET-CT. We calculated the ADC values to reflect the metabolic activity and celularity of the tumors instead of standardized uptake value (SUV) is used in the traditional method. Fifty patients (4 females and 46 males) were included in the study. The mean age was 63.4 years and the majority of the patients had a history of smoking (n=47, 94%). PET-CT and D-MRI showed the same radiological staging patterns. Overall, no correlation was found between SUVmax and total ADC / necrosis-free ADC (nADC) values (p = 0.68, p = 0.35). There was no significant correlation between total lesion glycolysis (TLG) and ADC and nADC (p = 0.19, p = 0.73). In subgroup analysis, negative correlation was found between ADC and SUVmax (p = 0.05, r = -0.42), SUVmax and nADC (p = 0.05, r = -0.35), TLG and ADC (p = 0.01, r = -0.47) and nADC (p = 0.03, r = -0.53) in small cell lung cancer patients. In subgroup analysis of non-small cell lung carcinoma cases, there were no correlation between SUVmax and ADC / nADC in adenocarcinomas (p = 0.73, p = 0.09). While there was no correlation between TLG and ADC (p = 0.16), there was a weak negative correlation between nADC (p = 0.04, r = -0.22). In squamous cell carcinoma cases, there was a strong negative correlation between SUVmax and ADC (p = 0.02, r = -0.81), SUVmax and nADC (p = 0.04, r= -0.79); There was a moderate negative correlation between TLG and ADC (p = 0.01, r =- 0.32) and ADC without necrosis (p = 0.05, r = -0.38). Diffusion MRI and PET-CT are similar in lung cancer staging and evaluating the metabolic characteristics of the tumor in patients with lung cancer. We believe diffusion MRI, as a promising imaging technique, will be used more frequently in the future.
Lung cancer is one of the most common and mortal cancers. Positron emision tomography – computerized tomography (PET-CT) is the most frequently used method in staging though it has some disadventages such as preparation of the patient, radiation exposure, long shooting time and isolated waiting times. On the other hand diffusion magnetic resonans imaging (D-MRI) which is mostly used for imaging of cranial lesions, is a radiation-free method that can be used as whole-body imaging and allows semiquantitative measurements with apperent diffusion coefficient (ADC). In this study, we have planned to assess the lung cancer patients with only the help of whole-body diffusion MRI, in comparison to regular lung cancer staging done with PET-CT. We calculated the ADC values to reflect the metabolic activity and celularity of the tumors instead of standardized uptake value (SUV) is used in the traditional method. Fifty patients (4 females and 46 males) were included in the study. The mean age was 63.4 years and the majority of the patients had a history of smoking (n=47, 94%). PET-CT and D-MRI showed the same radiological staging patterns. Overall, no correlation was found between SUVmax and total ADC / necrosis-free ADC (nADC) values (p = 0.68, p = 0.35). There was no significant correlation between total lesion glycolysis (TLG) and ADC and nADC (p = 0.19, p = 0.73). In subgroup analysis, negative correlation was found between ADC and SUVmax (p = 0.05, r = -0.42), SUVmax and nADC (p = 0.05, r = -0.35), TLG and ADC (p = 0.01, r = -0.47) and nADC (p = 0.03, r = -0.53) in small cell lung cancer patients. In subgroup analysis of non-small cell lung carcinoma cases, there were no correlation between SUVmax and ADC / nADC in adenocarcinomas (p = 0.73, p = 0.09). While there was no correlation between TLG and ADC (p = 0.16), there was a weak negative correlation between nADC (p = 0.04, r = -0.22). In squamous cell carcinoma cases, there was a strong negative correlation between SUVmax and ADC (p = 0.02, r = -0.81), SUVmax and nADC (p = 0.04, r= -0.79); There was a moderate negative correlation between TLG and ADC (p = 0.01, r =- 0.32) and ADC without necrosis (p = 0.05, r = -0.38). Diffusion MRI and PET-CT are similar in lung cancer staging and evaluating the metabolic characteristics of the tumor in patients with lung cancer. We believe diffusion MRI, as a promising imaging technique, will be used more frequently in the future.
Açıklama
Anahtar Kelimeler
Difüzyon MRG, PET-BT, SUV, Akciğer Kanseri, ADC, Diffusion MRI, Lung Cancer, PET-CT
