Direnç Özlem AKSOY, Zeynep Gamze KILIÇOĞLU, Gökalp YILMAZ, Ercüment KADIOĞLU, Seçil TELLİ, Mehmet Masum ŞİMŞEK

Dinamik kontrastlı manyetik rezonans incelemede morfolojik ve kinetik parametrelerin meme lezyonlarının iyi ve kötü huylu ayırımına katkısı

Amaç: Memenin dinamik kontrastlı manyetik rezonans görüntülemesinde (DK-MRG) kalitatif morfolojik ve kinetik veriler ile kantitatif kinetik verilerin, lezyonların malign-benign ayırımındaki katkısını değerlendirme. Yöntemler: Dinamik kontrastlı meme manyetik rezonans görüntülemesi yapılan 49 hastada 95 lezyon, önce morfolojik ve kontrastlanma özellikleri bakımından değerlendirildi. Ayrıca, lezyonların kontrast sonrası kinetik davranış- ları değerlendirildi. Sonra kantitatif parametrelerden relatif enhansmanlar (E1, E2, Epeak), zirve zamanı (time-to-peak, Tpeak), eğri eğimi (Slope), sinyal enhansman oranı (SER) ve azami yoğunluk zaman oranı (MITR) değerleri hesaplandı. Tüm bu veriler patoloji sonuçları ile karşılaş- tırıldı. Bulgular: Morfolojik özelliklerden malignite için özgünlü- ğü en yüksek olan parametreler kitlesel lezyonlarda: spiküle kenar (%100), halkasal kontrastlanma (%97,87), dü- zensiz şekil (%95,74), düzensiz kenar (%91,49), kitlesel formasyon göstermeyen lezyonlarda: fokal alan (%91,49) olarak bulundu. Kinetik eğrinin değerlendirilmesinde, benign lezyonların %74,5 i tip 1, malign lezyonların %77,1 i tip 2-3 eğri paterni sergilemekteydi. Değerlendirmeye katılan kantitatif parametrelerden Epeak dışındakiler, lezyonların benign-malign ayırımında istatistiksel olarak anlamlı bulundu. Sonuç: Benign lezyonların morfolojik özelliklerinde karakteristik olarak tanımlayabileceğimiz özgünlüğü belirgin yüksek bir parametreye rastlamadık. Ancak malign lezyonlar için daha spesifik özellikler tanımlanabilmektedir. Malign ve benign lezyonlar, kinetik eğrinin erken dönem davranışı ile ayrılamamakta ancak orta-geç dönem seyrinin değerlendirilmesi ile anlamlı veriler elde edilmektedir. Değerlendirmeye kattığımız kantitatif veriler de lezyonların malign-benign ayırımında umut vaat etmektedir.

Comparison of morphological and kinetic parameters in distinction of benign and malignant breast lesions in dynamic contrast enhanced magnetic resonance imaging

Objective: To evaluate the value of qualitative morphological and kinetic data and quantitative kinetic data in distinction of malignancy in dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) of the breast. Methods: DCE-MRIs of 49 subjects were evaluated. Morphological and contrast enhancement parameters of 95 lesions were recorded in these subjects. Post-contrast kinetic behavior of these lesions were also investigated. Among the quantitative parameters, relative enhancements (E1, E2, Epeak), time-to-peak (Tpeak), slope of curve (Slope), signal enhancement ratio (SER), and maximum intensity time ratio (MITR) were calculated. These results were compared with the pathological diagnosis. Results: Spiculated contour (100%), rim enhancement (97.87%), irregular shape (95.74%), and irregular margin (91.49%) were the most specific morphological features of malignancy in mass lesions. In non-mass lesions, focal zone (91.49%) was the most specific feature of malignancy. 74.5% of the benign lesions showed type 1, 77.1% of the malignant lesions showed type 2 and 3 curves according to the kinetic curve evaluation. All quantitative parameters except Epeak were found to be statistically significant in distinction of malignancy. Conclusion: None of the morphological features of the benign lesions were found to be significantly specific. More specific features can be described for malignant lesions. Early behavior of the kinetic curve is not useful for diagnosis of malignancy but the intermediate and late behavior gives useful information. Quantitative data involved in this study might be promising.

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