Serebral Gliomaların Derecelendirilmesinde; MR Spektroskopi ve Perfüzyon MR Görüntüleme Bulguları ile Histopatolojik Bulguların Karşılaştırılması

Amaç: Serebral glial tümörlerin preoperatif derecelendirilmesinde noninvaziv bir yaklaşım olan MR spektroskopi ve perfüzyon MR görüntüleme tekniklerinin yararını araştırmaktır. Gereç ve Yöntem: Operasyon ya da stereotaktik biyopsi ile glial tümör tanısı alan 20 hasta (4 düşük derece, 16 yüksek derece) çalışmaya dahil edildi. Tüm hastalar girişimsel işlem öncesinde konvansiyonel MR, MR spektroskopi ve perfüzyon MR görüntüleme ile değerlendirildi. Konvansiyonel MRG’de kitle etkisi, ödem, kanama, nekroz, kistik alan ve kontrast tutulumu değerlendirildi. MR spektroskopide Cho, NAA, Cr, Cho/Cr, Cho/NAA ve LL metabolitleri değerlendirildi ve DSC MR perfüzyon tekniği ile de rCBV, rCBF ve MTT değerleri hesaplandı. Glial tümörler radyolojik olarak derecelendirildi ve histopatolojik sonuçlar ile karşılaştırıldı. Bulgular: Düşük ve yüksek evre glial tümörler arasında yapılan değerlendirmede; MR spektroskopide TmLL değerleri istatistiksel olarak anlamlı farklılık göstermekteydi. Perfüzyon MR incelemesinde ise rCBV ve rCBF değerleri arasında istatistiksel olarak anlamlı farklılık saptandı, ancak MTT değerleri arasında anlamlı farklılık saptanmadı. Sonuç: MR spektroskopi ve Perfüzyon MRG; glial tümörlerin derecelendirilmesinde faydalı fonksiyonel MRG yöntemleri olup, konvansiyonel MRG’ ye göre daha fazla bilgi sağlamaktadır. rCBV ölçümleri derecelemeyi değerlendirmede en iyi parametredir. LL ve rCBV’nin konvansiyonel MRG ile kombinasyonu glial tümörleri derecelendirmede en doğru sonucu verecektir.

Grading of Cerebral Gliomas: Comparison of MR Spectroscopy and Perfusion MR Findings with Histopathological Findings

Objective: To investigate the utility of MR spectroscopy and perfusion MR imaging techniques, which is a noninvasive approach in the preoperative grading of cerebral glial tumors. Material and Method: Twenty patients who were diagnosed with glial tumor by means of operation or stereotactic biopsy (4 low grade, 16 high grade) were included in this study. All the patients were evaluated by means of conventional MR, MR spectroscopy and perfusion MR imaging before the interventional procedure. The effect of the mass, edema, bleeding, necrosis, cystic area and contrast enhancement were evaluated by conventional MR. Metabolites of Cho, NAA, Cr, Cho / Cr, Cho / NAA and LL were evaluated in MR spectroscopy and rCBV, rCBF and MTT values were calculated with DSC MR perfusion technique. Glial tumors were graded radiologically and compared with the histopathological results. Results: At the end of the evaluation between low and high grade glial tumors, TmLL values showed statistically significant difference in MR spectroscopy. In perfusion MRI, a statistically meaningful difference was observed between rCBV and rCBF values, but no meaningful difference was observed between MTT values. Conclusion: MR spectroscopy and perfusion MRI are useful functional MRI methods in the grading of glial tumors, and they provide more information in comparison to conventional MRI. rCBV measurement is the best parameter for the evaluation of grading. The combination of LL and rCBV with conventional MRI will give the most accurate result in glial tumors grading.

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