NEŞE ASAL, Pınar Nergis KOŞAR, Mahmut DURMUŞ, Esin ÖLÇÜCÜOĞLU, Ömer YILMAZ, Uğur KOŞAR

Jinekolojik kitlelerde pelvik manyetik rezonans görüntüleme

Amaç: Bu çalışmanın amacı adneksiyel ve uterin kitle olgularında pelvik manyetik rezonans görüntüleme (MRG) tetkikinin tanısal etkinliğini ve ultrasonografi (US)‘ye katkısını değerlendirmektir. Gereç ve yöntem: Jinekolojik kitle ön tanısı ile başvuran (10-83 yaş arası) 62 hastadan 61’ine pelvik MRG incelemesi gerçekleştirildi. Bu hastaların içerisinden patoloji sonuçlarına ulaşılabilen ve takip sonuçları ile tanı konabilen 53 hasta çalışmaya dahil edildi. Hastalara çekim öncesi veya sonrasında birkaç gün içerisinde sadece transvajinal sadece transabdominal ya da transvajinal ve transabdominal yolla US incelemesi gerçekleştirildi. Çalışmaya dahil edilen hastaların postoperatif patoloji sonuçları ve opere olmayan hastalarda ise klinik ve radyolojik takip kesin tanı kabul edildi. Sonuçlar US ve MRG bulguları ile karşılaştırıldı. Bulgular: 53 hastada 62 pelvik lezyon saptandı. Lezyonların 42 (%66) tanesini adneksiyel kitle, 34 (%33) tanesini uterin patolojiler oluşturmaktaydı. Adneksiyel kitle saptanan 6 hastada bilateral adneksiyel lezyon, 3 hastada da ovoadneksiyel lojda aynı tarafta iki farklı lezyon saptandı. Uterin kitlelerin 14’ü serviks Ca, 4’ü leiomyom, 1’i endometrium Ca, 1 olgu da vajen Ca olarak belirlendi. MRG’de adneksiyel kitlelerin 40’ı (40/42), US’da 38‘i (38/42) vizualize edilebildi. MRG ve US’da uterin kitlelerin tümü vizualize edilebildi. Benign-malign kitlelerin ayırımı US ile % 80, MRG ile %85 doğrulukta yapıldı. Sonuç: MRG, iyi kontrast rezolüsyonu, multıplanar ve multısekans görüntüleme ve yumuşak doku patolojilerinin gösterilmesindeki üstünlükleri ile jinekolojik kitlelerin orijini ve karakterizasyonunda US’ye üstündür. Ancak bütün hastalarda jinekolojik bulgu dahilinde ilk görüntüleme yöntemi US olmalı, klinik şüphe halinde MRG’ye başvurulmalıdır.

Pelvic magnetic resonance imaging in gynecologic masses

Objective: The aim of this study was to evaluate the diagnostic efficiency and the addition of the pelvic magnetic resonance imaging (MRI) to the ultrasonography (US) in adnexal and uterine masses. Materials and methods: Magnetic resonance imaging was performed to 61 patients (age 10-83 years) who refer with gynecologic mass prediagnosis. The study includes 53 patients having histopathological diagnosis and follow up results. Transvaginal, transabdominal or pelvic US were performed to all patients before or after a few days of MRI. Postoperative histopathological results and clinical and radiological follow up were used for definite diagnosis. The results verified with US and MRI findings. Results: Totally 62 pelvic lesions detected in 53 patients. Forty-two of 62 lesions (66%) were adnexal masses, 20 of 62 lesions were uterine (34%) masses, six patients had bilateral adnexal lesions and three had two different lesions in the same ovoadnexal side. Fourteen of the uterine masses were cervix cancer, four were leiomyoma, one was endometrium cancer and one vaginal cancer. Forty (40/42) adnexal masses detected in MRI, and 38 (38/42) were detected in US. Distinction between benign and malign masses was made with 80% accuracy by US and 85% accuracy by MRI. Conclusion: MRI was superior to the US in detecting the origin and the characterization of the gynecologic masses with well contrast resolution, multiplanar and multisecans imaging and detecting the soft tissue pathologies. However, US should be the first screening modality in gynecologic cases, if necessary MRI could be performed.

PDF

___

1. Balan P. Ultrasonography, computed tomography and magnetic resonance imaging in the assesment of pelvic pathology. Eur J Radiol 2006;58(1):147-55.
2. Sohaih SA, Mills TD, Sahdev A, et al. The role of magnetic resonance imaging and ultrasound in patients with adnexal masses. Clin Radiol 2005;60(3);340-8.
3. Saini A, Dina R, Mclndoe GA, et al. Characterization of adnexal masses with MRI. AJR AmJ Roentgenol 2005;184(3);1004-9.
4. Rieber A, Nüssle K, Stöhr I, et al. Preoperative diagnosis ovarian tumors with MR imaging: comparison with transvaginal sonography, positron emission tomography, and histologic findings. AJR Am J Roentgenol 2001;177(1):123-9.
5. Kurtz AB, Tsimikas JV, Tempany CM, et al. Diagnosis and staging of ovarian cancer: comparative values of DoppIer and conventional US, CT and MR imaging correlated surgery and histopathologic analysis-Report of the Radiology Diagnostic Oncology Group. Radiology 1999;212(1):19-27.
6. Saba L, Guerriero S, Sulis R et al. Learning curve in the detection of ovarian and deep endometriosis by using Magnetic Resonance Comparison with surgical results. Eur J Radiol 2011;79(2):237-44.
7. Jeong YY, Outwater EK, Kang HK et al. Imaging evaluation of ovarian masses. Radiographics 2000;20(5):1445-70.
8. Bell DJ, Pannu HK. Radiological assessment of gynecologic malignancies. Obstet Gynecol Clin North Am 2011;38(!):45-68.
9. Chilla B, Hauser N, Singer G, et al. Indeterminate adnexal masses at ultrasound: effect of MRI imaging findings on diagnostic thinking and therapeutic decisions. Eur Radiology 2011;21(6):1301-10.
10. Bloomfıeld TH: Benign cystic teratomas of the ovary: a review of seventy-two cases. Eur J Obstet Gynecol and Reprod Biol 1987;25(3):231-7. 11. Glastonbury CM. The shading sign. Radiology 2002;224(1):199-201.
12. Kataoka ML, Togashi K, Yamaoka T, et al. Posterior cul-de-sac obliteration associated with endometriosis:MR iImaging evaluation. Radiology 2005;234(3):815-23.
13. Tamai K, Koyama T, Saga T, et al. MR features of physiologic and benign conditions of the ovary. Eur Radiology 2006;16(12):2700-11.
14. Zhang J, Ugnat AM, Clarke K, et al. Ovarian cancer histology- specific incidence trends in Canada 1969-1993:age-period-cohort analyses. Br J Cancer 1999;81(1):152-8.
15. Bent CL, Sahdev A, Rockall AG, et al. MRI appearances of borderline ovarian tumours. Clin Radiology 2009;64(4):430-8.
16. Ayhan A, Başaran M. Epitelyal over kanserleri. In: Güner H (ed), Jinekolojik Onkoloji 3. Baskı 2002:14;201-43.
17. Pretorius ES, Outwater EK, Hunt JL, et al. Magnetic resonance imaging of the ovary. Top Magn Reson Imaging 2001;12(2):131-46.
18. Kim SH. Granulosa cell tumor of the ovary: common findings and unusual appearances on CT and MR. J Comput Assist Tomogr 2002;26(5):756-61.
19. Murase E, Siegelman ES, Outwater EK, et al. Uterine leiomyomas: histopathologic features, MR imaging findings, differential diagnosis and treatment. Radiographics 1999;19(5):1179-97.
20. McCluggage WG, Wilkinson N. Metastatic neoplasms involving the ovary: a review with an emphasis on morphological and immunohistochemical features. Histopathology 2005;47(3):231-47.
21. Hann LE, Lui DM, Shi W, et al. Adnexal masses in women with breast cancer: US findings with clinical and histopathologic correlation. Radiology 2000;216(1):242-7.
22. Koyama T, Tamai K, Togashi K. Staging of carcinoma of the uterine cervix and endometrium. Eur Radiology 2007;17(8):2009-19.
23. Okamoto Y, Tanaka YO, Nishida M, et al. MR imaging of the uterine cervix: imaging-pathologic correlation. Radiographics 2003;23(2):425-45.
24. Mezrich R. Magnetic resonance imaging applications in uterine cervical cancer.. Magn Resonance Imag Clin North Am 1994;2(2):211-43.
25. Pakkal MV, Rudralingam V, McCluggage WG, et al. MR staging in carcinoma of the endometrium and carcinoma of the cervix. Ulster Med J 2004;73(1): 20-4.
26. Griffin N, Grant LA, Sala E. Magnetic resonance imaging of vaginal and vulval pathology. Eur Radiology 2008;18(6):1269-80.
27. Pattani SJ, Kier R, Deal R, et al. MRI of uterine leiomyosarcoma. Magn Reson Imaging 1995;13(2):331-3.
28. Low SC, Chong CL. A case of cystic leiomyoma mimicking an ovarian malignancy. Ann Acad Med Singapore 2004;33(3):371-4.