Lateral Ventrikül Görünür Difüzyon 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.

Anahtar Kelimeler:

Leptomeningeal karsinomatozis, manyetik rezonans görüntüleme, difüzyon ağırlıklı görüntüleme, GDK değeri, beyin omurilik sıvısı, viskozite

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 in pyogenic ventriculitis due to pleocytosis and the protein content has been reported. With similar argument, we hypothesized ADC in LMC can be decreased due to higher CSF viscosity caused by levated factors such as cell count, total protein. The purpose of our study was to evaluate whether increased CSF viscosity in LMC causes low ADC values in CSF. Thirty-one patients with LMC and 31 age and sex-matched subjects having normal brain MRI were included in this study. ADC measurements were made on both sides in posterior lateral ventricle (LV) and lateral pterigoid muscle (LPM). The ADC ratio (=ADCCSF/ADCLPM) was calculated by dividing the ADC values to prevent individual and device-dependent differences. ADCCSF and ADC ratios were compared between the groups. Both the ADCCSF and ADCCSF/ADCLPM ratio in the LMC group was lower than those in the control group with 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) for differentiating LMC and control groups. ADC value may be used as a complementary tool to increase diagnostic accuracy of LMC.

Keywords:

Leptomeningeal carcinomatosis, magnetic resonance imaging, diffusion weighted imaging, ADC value,

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