Lateral Ventriku l Go ru nu r Difu zyon Katsayısı Leptomeningeal Karsinomatozis Tanısında Yararlı Olabilir mi?

Leptomeningeal karsinomatozis (LMK), malign hücrelerin beyin-omurilik sıvısı içinde yayılımından kaynaklanır. Difüzyon ağrırlıklı görüntüleme görünür difüzyon katsayısı (GDK) ile kantifiye edilir. Piyojenik ventrikülitte pleositozdan ve protein içeriliğinden dolayı düşük GDK değerleri raporlanmıştır. Benzer argümanla, artmış hücre sayısı, total protein gibi faktörlere bağlı artmış viskozite, LMK’de GDK’yi azaltabilir. Bu çalışmada LMK’de artmış vizkozitenin BOS’ta düşük ADC değerlerine neden olup olmadığını araştırmak amaçlandı. Leptomeningeal metastazlı 31 olgu ve yaş ve cinsiyet uyumlu, beyin MRG’si normal 31 olgu çalışmaya dahil edildi. Her iki tarafta lateral ventrikül posteriorlarından ve lateral pterigoid kaslarından (LPK) GDK ölçümleri yapıldı. Bireysel ve cihaz-bağımlı farklılıları engellemek için GDK oranı (=GDKBOS/GDKLPK) hesaplandı. Grupların GDKBOS ve GDK oranları karşılaştırıldı. LMK grubundaki GDKBOS ortalama değeri, kontrol grubundaki değerden, istatistiksel olarak düşük bulundu. LMK grubundaki ortalama GDKBOS/GDKLPK oranı da kontrol grubundaki değerden istatikstiksel olarak daha düşüktü. ROC analizi, GDKBOS değeri için 2844 (sensitivite 51.61%, spesifite 96.77%, eğri altı alan 0.800) ve GDK oranı için 1.97 (sensitivite of 74.19%, spesifite 93.55, eğri altı alan0.833) sınır değeri ortaya koydu. GDK değeri, LMK tanısı doğruluğunu artırmak için tamamlayıcı bir araç olarak kullanılabilir.

Is Lateral Ventricle Apparent Diffusion Coefficient Value Useful in the Diagnosis of Leptomeningeal Carcinomatosis?

Leptomeningeal carcinomatosis (LMC) is caused by the spread of malignant cells within cerebrospinal fluid (CSF).Diffusion-weighted imaging (DWI) is quantified by the apparent diffusion coefficient (ADC) value. The decreased ADC of CSF inpyogenic ventriculitis due to pleocytosis and the protein content has been reported. With similar argument, we hypothesized ADC inLMC can be decreased due to higher CSF viscosity caused by levated factors such as cell count, total protein. The purpose of ourstudy was to evaluate whether increased CSF viscosity in LMC causes low ADC values in CSF. Thirty-one patients with LMC and31 age and sex-matched subjects having normal brain MRI were included in this study. ADC measurements were made on bothsides in posterior lateral ventricle (LV) and lateral pterigoid muscle (LPM). The ADC ratio (=ADCCSF/ADCLPM) was calculatedby dividing the ADC values to prevent individual and device-dependent differences. ADCCSF and ADC ratios were comparedbetween the groups. Both the ADCCSF and ADCCSF/ADCLPM ratio in the LMC group was lower than those in the control groupwith statistical significance. ROC analysis showed a cutoff value of 2844 for the ADCCSF (sensitivity 51.61%, specificity 96.77%,under curve 0.800) and a cutoff value of 1.97 for the ADC ratio (sensitivity 74.19%, specificity 93.55%, under curve 0.833) fordifferentiating LMC and control groups. ADC value may be used as a complementary tool to increase diagnostic accuracy of LMC.

PDF

___

1. Le Rhun E, Taillibert S, Chamberlain MC. Carcinomatous meningitis: Leptomeningeal metastases in solid tumors. Surg Neurol Int. 2013;4:265-88.
2. El Shafie RA, Böhm K, Weber D, Lang K, Schlaich F, et al. Outcome and prognostic factors following palliative craniospinal irradiation for leptomeningeal carcinomatosis. Cancer Manag Res. 2019;11:789-801.
3. Leal T, Chang JE, Mehta M, Robins HI. Leptomeningeal Metastasis: Challenges in Diagnosis and Treatment. Curr Cancer Ther Rev. 2011;7:319-27.
4. National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology: Central Nervous System Cancers. http://www.nccn.org/professionals/physician_gls/p df/cnspdf. 2016
5. Hyun JW, Park JH, Kang BG, Park EY, Park B, Joo J, et al. Diagnostic and prognostic values of cerebrospinal fluid CYFRA 21-1 in patients with leptomeningeal carcinomatosis. Oncotarget. 2017;8:53326-35.
6. Gil B, Hwang EJ, Lee S, Jang J, Choi HS, Jung SL, Ahn KJ, Kim BS et al. Detection of Leptomeningeal Metastasis by Contrast-Enhanced 3D T1-SPACE: Comparison with 2D FLAIR and Contrast-Enhanced 2D T1-Weighted Images. PLoS One. 2016;11:e0163081.
7. Debnam JM, Mayer RR, Chi TL, Ketonen L, Weinberg JS, Wei W, Groves MD, Guha-Thakurta N. Most common sites on MRI of intracranial neoplastic leptomeningeal disease. J Clin Neurosci. 2017;45:252-6.
8. Vaswani AK, Nizamani WM, Ali M, Aneel G, Shahani BK, Hussain S et al. Diagnostic Accuracy of Contrast-Enhanced FLAIR Magnetic Resonance Imaging in Diagnosis of Meningitis Correlated with CSF Analysis. ISRN Radiol. 2014;2014:578986.
9. Gupta PK, Awasthi R, Singh S, Behari S, Maria Das KJ, Gupta RK, Kumar S et al. Value of Minimum Apparent Diffusion Coefficient on Magnetic Resonance Imaging as a Biomarker for Predicting Progression of Disease Following Surgery and Radiotherapy in Glial Tumors from a Tertiary Care Center in Northern India. J Neurosci Rural Pract. 2017;8:185-93.
10. 10. Agostinho L, Horta M, Salvador JC, Cunha TM. Benign ovarian lesions with restricted diffusion. Radiol Bras. 2019;52:106-11.
11. Hong JT, Son BC, Sung JH, Kim IS, Yang SH, Lee SW, Park CK et al. Significance of diffusionweighted imaging and apparent diffusion coefficient maps for the evaluation of pyogenic ventriculitis. Clin Neurol Neurosurg. 2008;110:137-44.
12. Nayar G, Ejikeme T, Chongsathidkiet P, Elsamadicy AA, Blackwell KL, Clarke JM, Lad SP, Fecci PE et al. Leptomeningeal disease: current diagnostic and therapeutic strategies. Oncotarget. 2017;8:73312-28.
13. Baliyan V, Das CJ, Sharma R, Gupta AK et al. Diffusion weighted imaging: Technique and applications. World J Radiol. 2016;8:785‐98.
14. Duc NM, Huy HQ, Bang MTL, Truong LM, Tri VH, Canh BN, et al. Clinical Applications of Diffusion-Weighted Magnetic Resonance Imaging. Imaging in Medicine 2018;10:79-84