Asbestos ile İlişkili Plevral Hastalıklarda, Plevral Efüzyonların Transuda ve Eksüda Ayırımını Yapmada, Difüzyon Ağırlıklı MR Görüntülemenin Rolü

Amaç: Bu çalışmanın amacı asbestos ile ilişkili plevral hastalıklarda, plevral efüzyonların transuda ve eksuda ayrımını yapmada, difüzyon ağırlıklı MR görüntülemenin (dMRG) rolünü değerlendirmektir. Gereç ve Yöntem: Çalışmaya 33’ ü benign form ve 22’ si malign plevral mezotelyomalı olmak üzere 55 hasta dahil edildi. Kliniğimizde Ocak 2015 ve Şubat 2016 yılları arasında, 1.5 T MR ile dMRG incelemesi yapılan hasta dosyaları, retrospektif olarak incelendi. Difüzyon MR b değerleri 0,500, ve 1000 s/mm2 idi. Görünür Difüzyon Kat Sayısı (ADC) haritaları oluşturuldu. Plevral efüzyonlardan ortalama ADC değerleri ölçüldü. Bulgular: Ellibeş hastanın uygun ADC haritaları elde edildi. Benign plevral hastalıklı olgularda ortalama plevral efüzyon ADC değerleri; 3.61 ± 0.55 x 10-3 mm2/s, malign plevral mezotelyomalı (MPM) olgularda, ortalama plevral efüzyon ADC değerleri; 3.12 ± 0.62 x 10-3 mm2/s ölçüldü. ADC değerlerinin optimum cut-off değeri; 3.43 x 10-3 mm2/s, sensitivite %88.6 ve spesifite %84 bulundu. MPM li olgularda plevral efüzyon ortalama ADC değeri, benign plevral hastalıklı olgulardaki plevral efüzyon ortalama ADC değerinden anlamlı olarak düşük bulundu (p < 0.05). Sonuç: dMRG, asbestos ile ilişkili hastalıklarda plevral efüzyonların transuda ve eksuda ayırımını yapmada yardımcı olarak, MPM nin erken teşhis edilmesini sağlayabilir.

The Role of Diffusion-Weighted MR Imaging Differentiating Transudative and Exudative Pleural Effusions in Asbestos-Related Pleural Diseases

Objective: The aim of this study was to evaluate the ability of diffusion weighted magnetic resonance imaging (dMRI) in differentiating transudate pleural effusions from exudate pleural effusions with asbestos-related pleural diseases. Material and Method: This study included 55 patients. Thirty-three had a benign form of the disease and 22 had malignant pleural mesothelioma (MPM). The patient files and records belonging to ones who underwent dMRI on a 1.5 T MR system between January 2015 and February 2016 in our clinic were examined retrospectively. The dMRI was done with b values of 0,500 and 1000 s/mm2. The apparent diffusion coefficient (ADC) maps were generated and mean ADC values were measured from pleural effusions. Results: Appropriate ADC maps were obtained in 55 patients. The mean pleural effusion ADC values were 3.61 ± 0.55 x 10-3 mm2/s in benign pleural disease and 3.12 ± 0.62 x 10-3 mm2/s in MPM, respectively. The optimum cutoff point for ADC values was 3.43 x 10-3 mm2/s with a sensitivity of 88.6% and specificity of 84%. The mean ADC value of the effusions in malignant mesothelioma was significantly lower than that of benign pleural disease (p < 0.05). Conclusion: dMRI may help in the differential diagnosis of transudate and exudate pleural effusions that indicate to early detection of MPM with asbestos-related pleural diseases.

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