Sevgül Kara KÖSE, F. Demir APAYDIN, Kaan ESEN, Anıl ÖZGÜR, Engin KARA, Sema ERDEN

Difüzyon Ağırlıklı Manyetik Rezonans Görüntülemenin Benign ve Malign Adrenal Lezyonları Ayırt Etmedeki Değeri

Amaç: Difüzyon ağırlıklı görüntüleme (DAG) vücuttaki su moleküllerinin rastgele hareketlerini inceleyen bir fonksiyonel manyetik rezonans görüntüleme (MRG) tekniğidir. DAG intrakranial bozuklukların değerlendirilmesinde yaygın bir şekilde kullanılmasına rağmen, abdominal kitlelerin tespiti ve karakterizasyonunda kullanılmasına artan bir ilgi vardır. Bu çalışmada DAG"nin benign adrenal lezyonları malign olanlardan ayrımındaki yeterliliği araştırılmıştır. Materyal ve metod: Elli altı hastadaki 66 fokal adrenal lezyon çalışmaya dahil edildi. Histopatolojik sonucu veya radyolojik takibi olmayan lezyonlar dinamik adrenal bilgisayarlı tomografi ve/veya adrenal MRG ile karakterize edildi. Bu lezyonlar için DAG yapıldı ve üç farklı b değeri kullanılarak (b=500 s/mm2, b=750 s/mm2, b=1000 s/mm2) apparent diffusion coefficient (ADC) değerleri ölçüldü. Bulgular: Otuz dokuz benign lezyonun ortalama ADC değerleri b=500 s/mm2 için 1.54 x 10-3 mm2/s , b=750 s/mm2 için 1.01x 10-3 mm2/s ve b=1000 s/mm2 için 0.77 x 10-3 mm2/s ölçüldü. Yirmi yedi malign lezyonun ortalama ADC değerleri b=500 s/mm2, b=750 s/mm2 ve b=1000 s/mm2 için sırasıyla 1.69x 10-3 mm2/s, 1.14 x 10-3 mm2/s ve 0.86 x 10-3 mm2/s olarak tespit edildi. Her üç b değeri için benign ve malign lezyonların ADC değerleri arasında istatistiksel olarak anlamlı fark yoktu (p

Anahtar Kelimeler:

Adrenal tumor, malign, benign, manyetik rezonans görüntüleme, difüzyon ağırlıklı görüntüleme

Value of Diffusion Weighted Magnetic Resonance Imaging in Differentiation of Benign and Malignant Adrenal Lesions

Objective: Diffusion weighted imaging (DWI) is a functional magnetic resonance imaging (MRI) technique that explores the random motion of water molecules in the body. Although DWI has been widely applied in the evaluation of intracranial disorders, there is growing interest for its use in detection and characterization of abdominal masses. In this study, the efficiency of DWI in distinguishing benign adrenal focal lesions from malignant ones is investigated. Material and Methods: Sixty six adrenal focal lesions in 56 patients were included in the study. The lesions were characterized with dynamic adrenal computed tomography and/or adrenal MRI if there was not a histopathological result or radiological follow up. DWI was performed for these lesions and apparent diffusion coefficient (ADC) values were measured by using three different b values (b=500 sec/mm2, b=750 sec/mm2, b=1000 sec/mm2). Results: The mean ADC values of 39 benign lesions were 1.54 x 10-3 mm2/sec for b=500 sec/mm2, 1.01x 10-3 mm2/sec for b=750 sec/mm2 and 0.77 x 10-3 mm2/sec for b=1000 sec/mm2. The mean ADC values of 27 malignant lesions were found to be 1.69x 10-3 mm2/sec, 1.14 x 10-3 mm2/sec and 0.86 x 10-3 mm2/sec for b=500 sec/mm2, b=750 sec/mm2, b=1000 sec/mm2, respectively. There was not any statistically significant difference between ADC values of benign and malignant lesions for all three b values (p

Keywords:

Adrenal tumor, malign, benign, magnetic resonance imaging, diffusion weighted imaging,

PDF

___

Barzon L, Sonino N, Fallo F, Palu G, Boscaro M. Prevalence and natural history of adrenal incidentalomas. European Journal of Endocrinology. 2003; 149:273-85.
Barzon L, Boscaro M. Diagnosis and management of adrenal incidentalomas. J Urol. 2000; 163:398-407 .
Korobkin M, Brodeur FJ, Yutzy GG, et al. Differentiation of adrenal adenomas from nonadenomas using CT attenuation values. AJR Am J Roentgenol. 1996; 166:531-6.
Dunnick NR, Korobkin M, Francis I. Adrenal radiology: distinguishing benign from malignant adrenal masses. AJR Am J Roentgenol. 1996; 167:861-7.
Boland GW, Lee MJ, Gazelle GS, Halpern EF, McNicholas MM, Mueller PR. Characterization of adrenal masses using unenhanced CT: an analysis of the CT literature. AJR. 1998; 171:201-4.
Hoefnagel CA. Metaiodobenzylguanidine and somatostatin in oncology: Role in the management of neural crest tumors. Eur J Nucl Med. 1994; 21:561 T sushima Y, Takahashi-Taketomi A, Endo K. Diagnostic utility of diffusion-weighted MR imaging and apparent diffusion coefficient value for the diagnosis of adrenal tumors. J Magn Reson Imaging. 2009; 29:112-7.
Miller FH, Wang Y, McCarthy RJ, et al. Utilty of diffusion-weighted MRI in characterization of adrenal lesions. AJR. 2010; 194:179-85.
Kılıçkesmez Ö, İnci E, Atilla S, et al. Diffusionweighted imaging of the renal and adrenal lesions. J Comput Assist Tomogr. 2009; 33:828-33.
Elaine Caoili E M, Korbokin M, Francis I R, et al. Adrenal Masses: Characterization with Combined Unenhanced and Delayed Enhanced CT. Radiology. 2002; 222: 629-33.
Yazıcı Z, Doğan Ö, Mehmet K, Savcı G. Value of chemıcal shıft mr ımagıng ın dıagnosıs of adrenal masses: quantitative analysis. Diagnostic and İnterventional Radiology. 2002; 8:377-83.
Moseley ME, Cohen Y, Mintorovitch J, et al. Early detection of regional cerebral ischemia in cats: Comparison of diffusion and T2-weighted MRI and spectroscopy. Magn Reson Med. 1990; 14:330-46.
Le Bihan D . Molecular diffusion nuclear magnetic resonance imaging . Magn Reson Q. 1991 ;7:1-30.
Nicholson C, Phillips JM. Ion diffusion modified by tortuosity and volume fraction in the extracellular microenvironment of the rat cerebellum. J Physiol. 1981; 321:225-57.
Szaher A, Zhong J, Anderson AW, Gore JC. Diffusion-weighted imaging in tissues: theoretical models. NMR Biomed. 1995; 8:289-96.
Taouli B, Koh DM. Diffusion–weighted MR Imaging of the Liver. Radiology. 2010; 254:47-66.
O'Hare MJ; Monaghan P, Neville A M. The pathology of adrenocortical neoplasia: A correlated structural and functional approach to the diagnosis malignant disease. Hum Pathol. 1979; 10:137-54.
Le Bihan D, Breton E, Lallemand D, Aubin ML, Vignaud J, Laval-Jeantet M. Separation of diffusion and perfusion in intravoxel incoherent motion MR imaging. Radiology. 1988; 168:497-505.
Ichikawa T, Haradome H, Hachiya J, Nitatori T, Araki T. Diffusion-weighted MR imaging with single-shot echo-planar imaging in the upper abdomen: Preliminary clinical experience in 61 patients. Abdom Imaging. 1999; 24:456-61.
Szolar DH, Kammerhuber F. Quantitative CT evaluation of adrenal gland masses: a step forward in the differentiation between adenomas and nonadenomas? Radiology. 1997; 202:517-21.
Yazışma Adresi / Address for Correspondence: Dr. Kaan Esen Adana Numune Eğitim ve Araştırma Hastanesi Radyoloji Bölümü 01240,Yüreğir/ ADANA e-mail: kaanessen@yahoo.com geliş tarihi/received :25.05.2013 kabul tarihi/accepted:17.06.2013