Neşe ASAL, Pınar Nercis KOŞAR, Mahmut DUYMUŞ, Esin ÖLÇÜCÜOĞLU, Ömer YILMAZ, Uğur KOŞAR

Pelvic magnetic resonance imaging in gynecologic masses

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.

Anahtar Kelimeler:

Adneksiyel kitle, manyetik rezonans görüntüleme, ultrasonografi

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.

Keywords:

Adnexal mass, magnetic resonance imaging, ultrasonography,

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