Vertebral Metastaz, Dejenerasyon ve Spondilodiskitlerin Ayırıcı Tanısında Non-CPMG SS-FSE Difüzyon Ağırlıklı MR Görüntülemenin Katkısının Değerlendirilmesi
Amaç: Vertebral metastaz, Tip 1 vertebra plato değişikliği ve spondilodiskitli olgularda non-Carr-Purcell-Meibom-Gill (Non-CPMG) single-shot fast- spin-echo (SS-FSE) difüzyon ağırlıklı görüntüleme (DAG) tekniğini kullanarak elde edilen apperent diffusion coefficient (ADC) değerlerinin ve oranlarının ayırıcı tanıya katkısının değerlendirilmesidir. Gereç ve Yöntem: Yirmidört vertebral metastaz ve 18 spondilodiskit ile 15 Tip 1 vertebra plato değişikliği bulunan toplam 57 hasta Non-CPMG SS- FSE DAG tekniği ile incelenmiştir. Patolojik vertebraların ADC değerleri, patolojik ve normal vertebralardan elde edilen ADC değerlerinin oranlamasıyla bulunan ADC oranları hesaplandı. Bu değerler her üç hastalık grubu arasında ve spondilodiskitlerle Tip 1 dejenerasyonların birleştirilmesiyle oluşan benign ve malign nedenli gruplar arasında karşılaştırıldı. Bulgular: Çalışmamızda ADC haritalarında tüm olgularda yüksek sinyal intensitesi izlenmiştir. Normal ve patolojik vertebra ADC ortalamaları sırasıyla 0,25±0,05 mm mm2/sn ve 1,07±0,22 mm2/sn ölçülmüş olup istatistiksel olarak anlamlı farklılık saptandı. Hem spondilodiskit hem de tip 1 dejenerasyon grubunun ADC değerleri ve ADC oranları metastatik infiltrasyonu bulunan gruptan anlamlı olarak yüksekti. Sonuç: NonCPMG SS-FSE difüzyon ağırlıklı görüntüleme tekniği, FSE temeline dayanmasından dolayı manyetik alan inhomojenitelerinden kaynaklanan artefaktlara daha az yatkındır. Her ne kadar bazı olgularda örtüşmeler olsa da elde edilen ADC değerleri, oranları ve yeterli bir görüntü kalitesi ile vertebral kemik iliği patolojilerinin değerlendirmesinde katkıda bulunabilir.
Diffusion-Weighted Imaging of the Spinal Lesions as Spondylodiscitis, Metastases, and Degeneration with a Non-Carr-Purcell-Meibom-Gill Single-shot Fast Spin Echo Sequence
Objective: To determine the efficacy of apparent diffusion coefficient (ADC) values obtained by using non-Carr-Purcell-Meibom-Gill (Non-CPMG) single-shot fast-spin-echo (SS-FSE) diffusion weighted imaging (DWI) technique in the differential diagnosis of spondylodiscitis, type 1 spinal degenerative changes, and spinal metastases. Material and Method: Fifty-seven patients with 24 spinal metastases, 18 spondylodiscitis, and 15 type 1 spinal degenerative changes were examined by using non-CPMG SS-FSE DWI technique. The ADC values of affected vertebrae were calculated. In addition to the ADC values of the affected and normal vertebrae were rationed. The calculated ADC values and ratios were compared between spondylodiscitis, degeneration, and spinal metastasis. The patients were also grouped as benign and malignant processes. These groups were also compared with each other. Results: ADC maps of all three groups showed hyper signal intensity. The average ADC values for normal and pathological groups were 0.25 ± 0.05 mm2/sn and 1.07 ± 022 mm2/sn respectively. There was significantly difference between normal and pathological groups. The values and ratios of ADC in both spondylodiscitis and type 1 degeneration groups were significantly higher than metastatic group. There was statistically significant difference in the ADC values and ratios between benign and malignant groups. Conclusion: NonCPMG SS-FSE DWI is less prone to the magnetic suseptibility artefacts because it bases on FSE. Although there is some overlaping between groups the ADC values and ratios with sufficient image quality obtained by using Non-CPMG SS-FSE DWI may contributed to the evaluation of vertebra bone marrow disorders.
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