Günay RONA, Meral ARİFOĞLU, Nuray VOYVODA, Kenan ÇETİN, Lale DAMGACI

İDİYOPATİK GRANÜLOMATÖZ MASTİT LEZYONLARINDA STEROİD TEDAVİSİNE YANITIN DEĞERLENDİRİLMESİNDE DİFÜZYON AĞIRLIKLI MR GÖRÜNTÜLEMENİN ROLÜ

Amaç: Bu çalışmanın amacı, idiyopatik granülomatöz mastit (İGM) lezyonlarının steroit tedavisine yanıtını değerlendirmede, görünür bir difüzyon katsayısı (ADC) haritası ile difüzyon ağırlıklı manyetik rezonans görüntülemenin (DW MRG) rolünü araştırmaktı. Gereç ve Yöntem: Bu retrospektif çalışma, biyopsi ile kanıtlanmış İGM’li 58 kadın (ortalama yaş 32,91 yıl, aralık=22-55 yıl) hastanın 99 lezyonunu içeriyordu. Hastalar oral ve topikal steroidlerle tedavi edildi. Tüm tedavi öncesi ve tedavi sonrası MR incelemeleri değerlendirildi. Kitlelerin ve kitlesel olmayan kontrastlanmaların maksimum boyutu ölçüldü. Tedavi sonrası dinamik kontrastlı (DK) MR bulgularına göre hastalar tam yanıt, kısmi yanıt ve yanıtsız olarak sınıflandırıldı. Bulgular: İGM (0,933±0,317x10-3 mm2/sn) tarafından işgal edilen alanların ADC değerleri, kontralateral normal parankimden (1,259±0,423x10-3 mm2/sn) daha düşüktü. Lezyonların 22’si (%22,22) yanıtsız, 30’u (%30,30) kısmi yanıt ve 47’si tam yanıt (%47,47) grubundaydı. Üç tedavi grubunda tedavi öncesi ADC değerleri arasında anlamlı bir fark yoktu (p=0,228). Kısmi yanıt grubunda tedavi öncesi ve tedavi sonrası ADC değerleri arasında anlamlı fark vardı (p=0,001). Sonuç: İGM’de DW MR görüntüleme, tedaviye yanıtı izlemek için yararlı bir yöntemdir. Ancak tedaviye yanıtı tahmin etmede başarılı değildir.

Anahtar Kelimeler:

Granülomatöz mastitis, Manyetik rezonans görüntüleme, Difüzyon ağırlıklı MRG, Tedavi yanıtı, Steroid tedavisi

THE ROLE OF DIFFUSION-WEIGHTED MR IMAGING IN EVALUATING THE RESPONSE TO STEROID THERAPY IN IDIOPATHIC GRANULOMATOUS MASTITIS LESIONS

Objective: The aim of this study was to investigate the role of diffusion-weighted magnetic resonance imaging (DW MRI) with an apparent diffusion coefficient (ADC) map in evaluating the response to treatment of steroid-treated idiopathic granulomatous mastitis (IGM) lesions. Materials and Methods: This retrospective study included 99 lesions of 58 female patients (average age: 32.91 years; range: 22–55 years) with biopsy-proven IGM. Patients were treated with oral and topical steroids. All pre-treatment and post-treatment MR examinations were evaluated. The maximal size of the masses and nonmass enhancement (NME) lesions were measured. Patients were classified as complete response (CR), partial response (PR), and non-response (NR) according to the dynamic contrast-enhanced (DCE) MR findings after treatment. Results: ADC values of areas occupied by IGM (0.933±0.317x10-3 mm2/sec) were lower than contralateral normal parenchyma (1.259±0.423x10-3 mm2/sec). Twenty-two (22.22%) of the lesions were in the NR group, 30 (30.30%) in the PR group, and 47 (47.47%) in the CR group. There was no significant difference between the pre-treatment ADC values in NR, PR, and CR groups (p=0.228). There was a significant difference between the pre-treatment and post-treatment ADC values in the PR groups (p=0.001). Conclusion: DW MR imaging in IGM is a useful method to monitor the response to treatment. However, it is not successful in predicting response to treatment.

Keywords:

Granulomatous Mastitis, Magnetic Resonance Imaging, Diffusion-Weighted MRI, Treatment Response, Steroid Therapy,

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