Zafer KOZACIOĞLU, Tansu DEĞİRMENCİ, Burak ARSLAN, Tarık YONGUÇ, Özgür ÖZTEKİN, Elçin Ahu ÇÖLLÜ, Yüksel YILMAZ

Transrektal ultrason eşliğinde çoklu prostat biyopsilerinin etkinliğini arttırmada endorektal sarmal kullanılmadan yapılan difüzyon ağırlıklı manyetik rezonans görüntülemenin yeri

Amaç: İlk defa prostat biyopsisi endikasyonu konmuş hastalarda endorektal sarmal kullanılmadan biyopsi öncesi uygulanan difüzyon ağırlıklı manyetik rezonans görüntüleme DAMRG bulgularının biyopsi sonuçları ile korelasyonu araştırılmıştır. DA-MRG’nin transrektal ultrason TRUSG eşliğinde yapılacak prostat çoklu biyopsisine yol gösterip gösteremeyeceği araştırılmak istenmiştir.Gereç ve Yöntemler: Temmuz 2010 Ağustos 2011 tarihleri arasında hastanemiz üroloji polikliniğine başvuran, ilk defa prostat biyopsisi endikasyonu konulmuş, rektal muayenede pozitif bulgusu olmayan 34 hastaya DAMRG incelemesi yapıldı. PSA alt sınırı 2,5 ng/ml olarak alındı. Prostat biyopsisi alanları; sağ taraf: “a ”, sol taraf: “b ” olarak adlandırıldı. Her bir alandan alınan 2’şer kor biyopsi aynı tüpte olacak şekilde toplam 12 tüp halinde patolojik incelemeye ayrı ayrı gönderildi. Takiben hastaların patolojik bulguları ile TRUSG biyopsi öncesi DA-MRG bulguları karşılaştırıldı ve aradaki korelasyona bakıldı.Bulgular: Prostat kanseri PK tespit edilen hastaların ortalama PSA değeri 7,0 ± 2,6 idi. Toplamdaki 34 hastanın 9 tanesinde PK saptandı %26 . Biyopsi sonucu PK olan 9 hastanın 6 tanesinde DA-MRG’nde şüpheli olarak rapor edilen alanlar ile patolojik veriler uyumlu bulundu %67 . Organa özgül uyumluluk ise 9 hastanın 8’inde vardı %88.8 . Pozitif yorum gücü 8/20 %40 , negatif yorum gücü 13/14 %92,8 , genel doğruluk oranı 21/34 %61,8 olarak bulunmuştur. Sonuç: İdeale yakın bir prostat örneklemesi için endorektal sarmal kullanılmadan yapılan DA-MRG’nin henüz kat etmesi gereken yol olduğunu düşünmekteyiz. Hastalara en az zarar vererek, tümör odaklarını en yüksek verimlilikle saptayacak ideal yöntemin bulunması için bu ve benzeri çalışmaların daha geniş kapsamlı ve geliştirilerek yapılması gereğine inanmaktayız

Anahtar Kelimeler:

Prostat kanseri, tanı, radyoloji, MRG

The role of diffusion weighted magnetic resonance imaging without endorectal coil in increasing the efficiency of transrectal ultrasound guided prostate biopsies

Objective: To study the effectiveness of diffusion weighted magnetic resonance imaging DW-MRI without the use an endorectal coil on detecting prostate zones with malignancy prior to prostate biopsies and to see whether the method can serve as a guide prior to transrectal ultrasound guided prostate biopsies. Materials and Methods: Between July 2010-August 2011, 34 patients with an indication for a prostate biopsy with no positive findings on digital rectal examination underwent DW-MRI. The lowest limit for PSA was 2,5ng/ ml. The zones of biopsy were marked as: “a 1- 6 ” for the right side and “b 1-6 ” for the left side. 2 biopsy cores were taken from every zone and the specimens for every zone were sent to pathology separately in 12 tubes. Pathologic findings were matched with the prebiopsy DWMRI findings for a possible correlation. Results: The mean PSA value for patients with prostate cancer PCa was 7,0 ± 2,6. PCa was detected in 9/34 patients 26% . Out of the 9 patients with a malignant biopsy, 6 had positive correlation in terms of Pca findings on DW-MRI 67% , whereas 8/9 88,8% patients were only organ specific. Positive predictive value was 8/20 40% and negative predictive value was 13/14 92,8% with an overall predictive value of 21/34 61,8% .Conclusion: DW-MRI without endorectal coil needs more development before acting as a guide for TRUSG guided prostate biopsies. We believe that, in order to find the ideal method to diagnose the tumors most efficiently and with the least complication rates, more expanded studies with larger series have to be done

Keywords:

Prostate cancer, diagnosis, radiology, MRI,

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