Magnetnorezonantna sekvenca difuzionog kretanja u proceni metastatske invazije limfnih čvorova kod malignih tumora ženskih polnih organa

  • Marijana Basta Nikolić University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia;University Clinical Center of Vojvodina, Center for Radiology, Novi Sad, Serbia
  • Dragan Nikolić University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; University Clinical Center of Vojvodina, Clinic for Vascular and Transplantation Surgery, Novi Sad, Serbia
  • Sanja Stojanović University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia;University Clinical Center of Vojvodina, Clinic for Vascular and Transplantation Surgery, Novi Sad, Serbia
  • Srdjan Djurdjević University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia;University Clinical Center of Vojvodina, †Center for Radiology, ‡Clinic for Vascular and Transplantation Surgery, Clinic for Gynecology and Obstetrics, Novi Sad, Serbia
  • Olivera Nikolić University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia;University Clinical Center of Vojvodina, Center for Radiology, Novi Sad, Serbia
  • Viktor Till University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; University Clinical Center of Vojvodina, Center for Radiology, Novi Sad, Serbia
DOI: https://doi.org/10.2298/VSP190726102B
Ključne reči: dijagnoza, diferencijalna;, magnenta rezonanca, difuziona;, polni organi, ženski;, limfne žlezde;, neoplazme, limfna metastaza;, magnetna rezonanca, snimanje.

Sažetak


Uvod/Cilj. Funkcionalna radiološka dijagnostika, uključujući i magnentnorezonantnu sekvencu difuzionog kretanja (diffusion-weighted magnetic resonance imaging – DWIMRI) i iz nje izvedenu mapu očiglednog koeficijenta difuzije – apparent diffusion coefficient (ADC), daju obećavajuće rezultate u mogućnosti razlikovanja benignih od maligno izmenjenih limfnih čvorova male karlice i ingvinuma kod bolesnica sa malignim tumorima ženskih polnih organa. Cilj rada bio je da se procene dijagnostičke osobine DWI u razlikovanju benigno- od maligno-izmenjenih pelvičnih i ingvinalnih limfnih čvorova kod bolesnica sa ginekološkim malignim oboljenjima. Metode. Prospektivnom kliničkom studijom, sprovedenom u Kliničkom centru Vojvodine, u periodu od 2013. do 2016. godine, obuhvaćeno je 80 bolesnica sa malignim tumorima ženskih polnih organa. Svim bolesnicama je preoperativno učinjen magnetnorezonantni pregled male karlice, uz naknadno sprovedeno standardno hirurško lečenje po protokolu hirurškog lečenja za dato maligno ginekološko oboljenje sa karličnom i/ili ingvinalnom limfadenektomijom. Na osnovu definisanog modela koji kombinuje kriterijum ADC vrednosti sa kriterijumom veličine, MRI ima sledeće dijagnostičke performanse za


razlikovanje maligno- od benigno- izmenjenih limfnih čvorova: senzitivnost od 95%, specifičnost od 92%, sveukupnu tačnost od 92,5%, pozitivnu prediktivnu vrednost od 46% i negativnu prediktivnu vrednost od 99.6%. Postoperativno je izvršena patohistološka analiza hirurški uklonjenih materijala i limfnih čvorova razdvojenih po anatomskim grupama u karlici i ingvinalnoj regiji. Rezultati. Ukupno 2 320 limfnih čvorova mapirano je i patohistološki pregledano kod 80 bolesnica. Metastaze u limfnim čvorovima patohistološki su verifikovane kod 28 (35%) bolesnica. Izmerena ADC vrednost bila je značajno niža kod metastatski izmenjenih limfnih čvorova [srednja vrednost (SV) ± standardna devijacija (SD), ADC: 0,8725 × 10-3 mm2/s ± 0,0125 × 10-3 mm2/s] u poredjenju sa limfnim čvorovima koji nisu bili metastatski izmenjeni (SV ± SD, ADC: 1,116 × 10-3 mm2/s ± 0,1848 × 10-3 mm2/s; p = 0,001). Za ADC vrednost od 0,860 × 10-3 mm2/s, kao kritičnu vrednost za razlikovanje metastatskih od limfnih čvorova koji nisu bili metastatski izmenjeni, senzitivnost DWI MR iznosila je 89%, specifičnost 85%, ukupna tačnost 86%, pozitivna prediktivna vrednost 30%, a negativna prediktivna vrednost 99%. Zaključak. Magnentnorezonantna sekvenca difuzionog kretanja je brza, jednostavna, neinvazivna metoda koja značajno doprinosi dijagnostičkim mogućnostima magnetne rezonance u razlikovanju benigno- od maligno-izmenjenih limfnih čvorova male karlice i ingvinuma.

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Objavljeno
2022/05/11
Broj časopisa
Vol. 79 Br. 3 (2022)
Rubrika
Originalni članak