Neriman Zengin FISTIKÇIOĞLU, Mesude TOSUN, Nagihan İnan GÜRCAN, Hande USLU

KARACİĞER FİBROZİSİNİN DEĞERLENDİRİLMESİNDE KONVANSİYONEL DİFÜZYON, DİFÜZYON TENSÖR GÖRÜNTÜLEME VE DİNAMİK DUYARLILIK KONTRASTLI MANYETİK REZONANS PERFÜZYON GÖRÜNTÜLEMENİN ETKİNLİĞİNİN KARŞILAŞTIRILMASI

Amaç: Karaciğer fibrozu, karaciğer yetmezliğine neden olabilen dinamik, geri dönüşümlü bir süreçtir. Teşhis ve evreleme için noninvaziv yöntemlerin geliştirilmesine büyük ilgi vardır. 3Tesla MR'da konvansiyonel difüzyon ağırlıklı görüntüleme (DAG), difüzyon tensör görüntüleme (DTG) ve T2* ağırlıklı dinamik duyarlılık kontrastlı manyetik rezonans perfüzyon görüntüleme (DDK-MRPG) ile fibrotik karaciğer parankiminin difüzyon ve perfüzyon değişikliklerini araştırmayı amaçladık. Yöntem: Kronik viral hepatiti olan 27 hasta ve 24 gönüllü prospektif olarak değerlendirildi. Rutin batın MR protokolüne ek olarak DAG ve DTG uygulandı. Görünür difüzyon katsayısı (ADC) haritaları elde edildi, DTG için D ve FA değerleri hesaplandı. Sinyal Yoğunluğu (SI)-zaman eğrisi elde edildi ve “kan volümü” (KV), “kan akımı” (KA), “pik zamanı” (PZ), “ortalama geçiş zamanı” (OGZ) ölçüldü. Hepatitli tüm hastalara karaciğer biyopsisi yapıldı. Fibrozis tanısında kullanılan difüzyon ve perfüzyon parametrelerinin etkinliği, ROC eğrisi ile analiz edildi. Bulgular: Hastalar, DAG ve DTG de kontrol grubuna kıyasla önemli ölçüde daha düşük karaciğer ADC'sine sahipti, DTG’den elde edilen D değerleri hastalarda, sağlıklı gönüllülere göre düşük olup fark istatistiksel olarak anlamlıydı. DDK-MRPG hakkında; Karaciğerin KA, KV, OGZ ve PZ’nı kontrol grubuna göre daha düşüktü ancak sadece KV ve OGZ değerleri istatistiksel anlamlılık gösterdi. Karaciğer ADC, D ve KV değerleri fibrozis ile negatif korelasyona sahipti. Sonuç: DDK-MRPG'den elde edilen KV ve OGZ, DTG’den elde edilen D değerlerinin kronik hepatitli hastalarda karaciğer fibrozisi için etkili bir tanı aracı olabileceğini gösterdi.

COMPARISON OF THE EFFICIENCY OF CONVENTIONAL DIFFUSION, DIFFUSION TENSOR IMAGING, AND DYNAMIC SUSCEPTIBILITY CONTRAST-ENHANCED MAGNETIC RESONANCE PERFUSION IMAGING IN THE EVALUATION OF LIVER FIBROSIS

Objective: Liver fibrosis is a dynamic, reversible process that can result in liver failure. There has been considerable interest in developing noninvasivemethods for diagnosis and staging. To investigate the diffusion and perfusion changes of the fibrotic liver parenchyma with conventional diffusion-weightedimaging (CDI), diffusion tensor imaging (DTI), and T2*weighted dynamic susceptibility contrast-magnetic resonance perfusion imaging (DSC-MRPI) at3Tesla MR scanner.Methods: Twenty-seven patients with chronic viral hepatitis and 24 volunteers were evaluated, prospectively. The standard MRI protocols of the abdomen,CDI, and DTI were performed. Apparent diffusion coefficient (ADC) maps were obtained, D and FA values were calculated for DTI. Signal Intensity(SI)-time curves were obtained and “blood volume”(BV), “blood flow” (BF), “time to peak”(TTP), “mean transit time”(MTT) were measured. All patients withhepatitis underwent liver biopsy. The efficacy of diffusion and perfusion parameters used in the diagnosis of fibrosis was analyzed with the receiver operatingcharacteristic curve (ROC).Results: Patients had significantly lower liver ADC when compared to the control group, either with CDI and DTI. D values obtained from DTI were lowerin patients than those of the normal volunteers, and the difference was statistically significant. On DSC-MRPI; BF, BV, MTT, and TTP of the liver werelower than those of the control group but only BV and MTT values showed statistical significance. Liver ADC, D, and BV values had a negative correlationwith fibrosis.Conclusion: The results showed that the D values obtained from DTI, BV, and MTT values obtained from DSC-MRPI can be an efficient diagnostic tool forliver fibrosis in patients with chronic hepatitis.

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