Plevra Tabanlı Kitlelerde Shear Wave Elastografi Ve Difüzyon Mrg Bulgularının Histopatolojik Bulgular ile Korelasyonu
Abstract
Amaç: Non-invaziv tanısal yöntemler olan shear wave elastografi (SWE) ve difüzyon ağırlıklı magnetik rezonans görüntülemenin (DAG), toraksta plevra tabanlı kitlelerde benign ve malign lezyonların ayırımında kullanılabilirliklerinin histopatolojik bulgular ile karşılaştırılarak değerlendirilmesi amaçlanmıştır.
Gereç ve Yöntem: Mart 2015 ile Mart 2018 tarihleri arasında girişimsel radyoloji ünitesine transtorasik biyopsi amacıyla başvuran, bilgisayarlı tomografide (BT) plevra tabanlı kitle izlenen ve biyopsiye uygun bulunan 63 olgu çalışmaya dahil edilmiştir. Tüm olgulara DAG yapılmış ve kitlelerin ADC değerleri ölçülmüştür. Tüm olgulara SWE uygulanmış ve en yüksek SW hızı ölçülen alandan transtorasik biyopsi yapılmıştır. Histopatolojik olarak benign ve malign olduğu belirlenen lezyonların DAG ve SWE bulguları karşılaştırılmıştır.
Bulgular: Olguların 56’sı erkek, 7’si kadındı. Ortalama yaş 64.68±10.13 idi (41-85). Olguların 44’ü malign, 19’u ise benigndi. Malign olgularda maksimum SW hızı ortalama 4.13±0.59 m/sn, benign olgularda ise 3.55±0.71 m/sn ölçülmüş olup fark anlamlı idi (p=0.001). Malign olgularda mean ADC 1.04±0.30 x 10-3 mm2/sn, benign olgularda ise 1.32±0.33 x 10-3 mm2/sn ölçülmüş olup fark anlamlı idi (p=0.002). Malign olgularda minimum ADC 0.73±0.29 x 10-3 mm2/sn; benign olgularda ise 0.99±0.44 x 10-3 mm2/sn ölçülmüş olup fark yine anlamlı idi (p=0.024). ROC analizi sonucu maksimum SW hızı değeri ≥ 4.08 m/sn, mean ADC değeri ≤1.01x10-3 mm2/sn ve minimum ADC değeri ≤ 0.8x10-3 mm2/sn malign tanısı için cut-off değeri olarak alındığında, başarılı şekilde malign-benign ayrımı yapılabilmekteydi.
Sonuç: Transtorasik US elastografi ve difüzyon MR, uygun olgularda malign-benign lezyon ayrımında yararlıdır. Hem SWE, hem de difüzyon MR incelemesi, radyasyon içermemeleri ve non-invaziv olmaları nedeniyle rutin kullanımda kullanışlı yöntemlerdir. Özellikle SWE, biyopsi kılavuzluğu için uygun olup yetersiz materyal olasılığını engelleyebilir.
Keywords
Supporting Institution
Düzce Universitesi Bilimsel Araştırma Projeleri BAP-2015.04.03.309.
Project Number
BAP-2015.04.03.309
References
- 1. Rhymer JC: Elastography in the detection of prostatic cancer. Clin Radiol 2003; 58(4): 337.
- 2. Xu JM, Xu XH, Xu HX, Zhang YF, Zhang J, Guo LH, et al. Conventional US, US elasticity imaging, and acoustic radiation force impulse imaging for prediction of malignancy in thyroid nodules. Radiology 2014; 272(2): 577-86.
- 3. Guo LH, Wang SJ, Xu HX, Sun LP, Zhang YF, Xu JM, et al. Differentiation of benign and malignant focal liver lesions: Value of virtual touch tissue quantification of acoustic radiation force impulse elastography. Med Oncol 2015; 32(3): 68.
- 4. Ko KH, Jung HK, Kim SJ, Kim H and Yoon JH: Potential role of shear-wave ultrasound elastography for the differential diagnosis of breast non-mass lesions: Preliminary report. Eur Radiol 2014;24(2): 305-11.
- 5. Samir AE, Dhyani M, Vij A, Bhan AK, Halpern EF, Méndez-Navarro J, et al. Shear-Wave Elastography for the Estimation of Liver Fibrosis in Chronic Liver Disease: Determining Accuracy and Ideal Site for Measurement. Radiology. 2015; 274(3):888-96.
- 6. Ucan B, Sahin M, Onal B, Kizilgul M, Duger H, Sencar ME, Cakal E, Ozbek M. Assessment of diagnostic value of preoperative elastography in thyroid nodules having indeterminate cytology results. Turk J Med Sci. 2021 Jul 22. doi: 10.3906/sag-2101-246.
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- 13. Gültekin S. Ultrasonografide Yeni Uygulamalar. Türk Radyoloji Seminerleri 2014; 2: 158-70.
- 14. Ozturk A, Grajo JR, Dhyani M, Anthony BW, Samir AE. Principles of ultrasound elastography. Abdom Radiol 2018;43(4):773-85.
- 15. Koh DM, Burke S, Davies N, Padley SP. Transthoracic US of the chest: clinical uses and applications. Radiographics. 2002 Jan-Feb;22(1):e1.
- 16. Michael C, Hiroshima K, Hjerpe A. Michelow P, Önal B, Segal. A.Malignant-Primary (MAL-P) (Mesothelioma). In: Chandra A, Crothers B, Kurtycz D, Schmitt F. (eds) The International System for Serous Fluid Cytopathology. Springer, Cham. 2020. http://doi.org/10.1007/978-3-030-53908-5_
- 17. Mostbeck G. Elastography everywhere - now even the lungs! Ultraschall Med. 2014 ;35(1):5-8.
- 18. Adamietz BR, Fasching PA, Jud S, Schulz-Wendtland R, Anders K, Uder M, et al. M. Ultrasound elastography of pulmonary lesions - a feasibility study. Ultraschall Med. 2014;35(1):33-7.
- 19. Sperandeo M, Trovato FM, Dimitri L, Catalano D, Simeone A, Martines GF, et al. Lung transthoracic ultrasound elastography imaging and guided biopsies of subpleural cancer: a preliminary report. Acta Radiol. 2015;56(7):798-805.
- 20. Lim CK, Chung CL, Lin YT, Chang CH, Lai YC, Wang HC, et al. Transthoracic Ultrasound Elastography in Pulmonary Lesions and Diseases. Ultrasound Med Biol. 2017;43(1):145-52.
- 21. Ozgokce M, Yavuz A, Akbudak I, Durmaz F, Uney I, Aydin Y, et al I. Usability of Transthoracic Shear Wave Elastography in Differentiation of Subpleural Solid Masses. Ultrasound Q. 2018;34(4):233-37.
- 22. Wei H, Lu Y, Ji Q, Zhou H, Zhou X. The application of conventional us and transthoracic ultrasound elastography in evaluating peripheral pulmonary lesions. Exp Ther Med. 2018;16(2):1203-08.
- 23. Luna A, Sánchez-Gonzalez J, Caro P. Diffusion-weighted imaging of the chest. Magn Reson Imaging Clin N Am. 2011;19(1):69-94.
- 24. Nakayama J, Miyasaka K, Omatsu T, Onodera Y, Terae S, Matsuno Y, et al. Metastases in mediastinal and hilar lymph nodes in patients with non-small cell lung cancer: quantitative assessment with diffusion-weighted magnetic resonance imaging and apparent diffusion coefficient. J Comput Assist Tomogr. 2010;34(1):1-8.
- 25. Guimaraes MD, Hochhegger B, Santos MK, Santana PR, Sousa AS Júnior, Souza LS, Marchiori E. Magnetic resonance imaging of the chest in the evaluation of cancer patients: state of the art. Radiol Bras. 2015 Jan-Feb;48(1):33-42.
Shear Wave Ultrasound Elastography and Diffusion-Weighted Magnetic Resonance Imaging Findings of Pleural-Based Masses with Histopathologic Correlation
Abstract
Objective: The study aims to evaluate the usefulness of non-invasive diagnostic methods, shear wave elastography (SWE), and diffusion-weighted magnetic resonance imaging (DWI) to differentiate benign and malignant lesions in the thoracic pleural based masses by comparing them with histopathological findings.
Materials and Methods: Sixty-three patients having a pleural-based peripheral mass on CT, admitted to the interventional radiology department for transthoracic biopsy, were included in the study. All patients underwent DWI, and ADC values of the groups were measured. Transthoracic biopsy was performed with the guidance of US from the area where the highest shear wave velocity (SWV) value was calculated. ADC and SWV values of histopathologically proven benign and malignant lesions were statistically compared.
Results: Fifty-six patients were male, and seven were female. The mean age was 64.68±10.13 years (41-85 years). Fourty-four patients were malignant, and 19 were benign. The maximum SWV was found to be 4.13±0.59 m/s in malignant cases and 3.55±0.71 m/s in benign cases, and the difference was significant (p = 0.001). Mean ADC value was measured as 1.04±0.30 x 10-3 mm2/s in malignant cases and 1.32±0.33 x 10-3 mm2/s in benign cases on DWI and the difference was significant (p = 0.002). In malignant cases, the minimum ADC was 0.73±0.29 x 10-3 mm2/s, and 0.99±0.44 x 10-3 mm2/s in benign cases, the difference was significant (p = 0.024). ROC analysis revealed a cut-off value of ≥4.08 m/s for SWVmax, ≤1.01x10-3 mm2/s for mean ADC, and ≤0.8x10-3 mm2/s for minimum ADC showed a significant performance in distinguishing malignant and benign lesions.
Conclusions: Transthoracic US elastography and DWI are useful in differentiating malignant and benign lesions in appropriate cases. Both SWE and DWI are useful in routine use because they are non-invasive and do not contain radiation. In particular, SWE is suitable for biopsy guidance and may prevent the possibility of insufficient material.
Project Number
BAP-2015.04.03.309
References
- 1. Rhymer JC: Elastography in the detection of prostatic cancer. Clin Radiol 2003; 58(4): 337.
- 2. Xu JM, Xu XH, Xu HX, Zhang YF, Zhang J, Guo LH, et al. Conventional US, US elasticity imaging, and acoustic radiation force impulse imaging for prediction of malignancy in thyroid nodules. Radiology 2014; 272(2): 577-86.
- 3. Guo LH, Wang SJ, Xu HX, Sun LP, Zhang YF, Xu JM, et al. Differentiation of benign and malignant focal liver lesions: Value of virtual touch tissue quantification of acoustic radiation force impulse elastography. Med Oncol 2015; 32(3): 68.
- 4. Ko KH, Jung HK, Kim SJ, Kim H and Yoon JH: Potential role of shear-wave ultrasound elastography for the differential diagnosis of breast non-mass lesions: Preliminary report. Eur Radiol 2014;24(2): 305-11.
- 5. Samir AE, Dhyani M, Vij A, Bhan AK, Halpern EF, Méndez-Navarro J, et al. Shear-Wave Elastography for the Estimation of Liver Fibrosis in Chronic Liver Disease: Determining Accuracy and Ideal Site for Measurement. Radiology. 2015; 274(3):888-96.
- 6. Ucan B, Sahin M, Onal B, Kizilgul M, Duger H, Sencar ME, Cakal E, Ozbek M. Assessment of diagnostic value of preoperative elastography in thyroid nodules having indeterminate cytology results. Turk J Med Sci. 2021 Jul 22. doi: 10.3906/sag-2101-246.
- 7. Karaman A, Kahraman M, Bozdoğan E, Alper F, Akgün M. Diffusion magnetic resonance imaging of thorax. Tuberk Toraks. 2014;62(3):215-30.
- 8. Henzler T, Schmid-Bindert G, Schoenberg SO, Fink C. Diffusion and perfusion MRI of the lung and mediastinum. Eur J Radiol. 2010;76(3):329-36.
- 9. Razek AA. Diffusion magnetic resonance imaging of chest tumors. Cancer Imag. 2012;12(3):452–63.
- 10. Meier-Schroers M, Homsi R, Skowasch D, Buermann J, Zipfel M, Schild HH, Thomas D. Lung cancer screening with MRI: results of the first screening round. J Cancer Res Clin Oncol. 2018;144(1):117-25.
- 11. Aktas AR, Gozlek E, Yazkan R, et al. Transthoracic biopsy of lung masses: Non technical factors affecting complication occurrence. Thoracic Cancer. 2015;6(2):151-58.
- 12. de Margerie-Mellon C, de Bazelaire C, de Kerviler E. Image-guided biopsy in primary lung cancer: Why, when and how. Diagn Interv Imaging. 2016;97(10):965-72.
- 13. Gültekin S. Ultrasonografide Yeni Uygulamalar. Türk Radyoloji Seminerleri 2014; 2: 158-70.
- 14. Ozturk A, Grajo JR, Dhyani M, Anthony BW, Samir AE. Principles of ultrasound elastography. Abdom Radiol 2018;43(4):773-85.
- 15. Koh DM, Burke S, Davies N, Padley SP. Transthoracic US of the chest: clinical uses and applications. Radiographics. 2002 Jan-Feb;22(1):e1.
- 16. Michael C, Hiroshima K, Hjerpe A. Michelow P, Önal B, Segal. A.Malignant-Primary (MAL-P) (Mesothelioma). In: Chandra A, Crothers B, Kurtycz D, Schmitt F. (eds) The International System for Serous Fluid Cytopathology. Springer, Cham. 2020. http://doi.org/10.1007/978-3-030-53908-5_
- 17. Mostbeck G. Elastography everywhere - now even the lungs! Ultraschall Med. 2014 ;35(1):5-8.
- 18. Adamietz BR, Fasching PA, Jud S, Schulz-Wendtland R, Anders K, Uder M, et al. M. Ultrasound elastography of pulmonary lesions - a feasibility study. Ultraschall Med. 2014;35(1):33-7.
- 19. Sperandeo M, Trovato FM, Dimitri L, Catalano D, Simeone A, Martines GF, et al. Lung transthoracic ultrasound elastography imaging and guided biopsies of subpleural cancer: a preliminary report. Acta Radiol. 2015;56(7):798-805.
- 20. Lim CK, Chung CL, Lin YT, Chang CH, Lai YC, Wang HC, et al. Transthoracic Ultrasound Elastography in Pulmonary Lesions and Diseases. Ultrasound Med Biol. 2017;43(1):145-52.
- 21. Ozgokce M, Yavuz A, Akbudak I, Durmaz F, Uney I, Aydin Y, et al I. Usability of Transthoracic Shear Wave Elastography in Differentiation of Subpleural Solid Masses. Ultrasound Q. 2018;34(4):233-37.
- 22. Wei H, Lu Y, Ji Q, Zhou H, Zhou X. The application of conventional us and transthoracic ultrasound elastography in evaluating peripheral pulmonary lesions. Exp Ther Med. 2018;16(2):1203-08.
- 23. Luna A, Sánchez-Gonzalez J, Caro P. Diffusion-weighted imaging of the chest. Magn Reson Imaging Clin N Am. 2011;19(1):69-94.
- 24. Nakayama J, Miyasaka K, Omatsu T, Onodera Y, Terae S, Matsuno Y, et al. Metastases in mediastinal and hilar lymph nodes in patients with non-small cell lung cancer: quantitative assessment with diffusion-weighted magnetic resonance imaging and apparent diffusion coefficient. J Comput Assist Tomogr. 2010;34(1):1-8.
- 25. Guimaraes MD, Hochhegger B, Santos MK, Santana PR, Sousa AS Júnior, Souza LS, Marchiori E. Magnetic resonance imaging of the chest in the evaluation of cancer patients: state of the art. Radiol Bras. 2015 Jan-Feb;48(1):33-42.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Articles |
| Authors | |
| Project Number | BAP-2015.04.03.309 |
| Publication Date | October 18, 2021 |
| Acceptance Date | May 1, 2021 |
| Published in Issue | Year 2021 Volume: 13 Issue: 3 |
