Investigative Magnetic Resonance Imaging

Korean Society of Magnetic Resonance in Medicine (대한자기공명의과학회)
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Pre-operative Evaluation of Consistency in Intra-axial Brain Tumor with Diffusion-weighted Images (DWI) and Conventional MR Images

확산강조영상과 고식적 자기공명영상을 이용한 수술 전 축내 뇌종양의 경도 평가

  • Oh, Moon-Sik (Department of Radiology, Collage of Medicine, The Catholic University of Korea) ;
  • Ahn, Kook-Jin (Department of Radiology, Collage of Medicine, The Catholic University of Korea) ;
  • Choi, Hyun-Seok (Department of Radiology, Collage of Medicine, The Catholic University of Korea) ;
  • Jung, So-Lyung (Department of Radiology, Collage of Medicine, The Catholic University of Korea) ;
  • Lee, Yoon-Joo (Department of Radiology, Collage of Medicine, The Catholic University of Korea) ;
  • Kim, Bum-Soo (Department of Radiology, Collage of Medicine, The Catholic University of Korea)
  • 오문식 (가톨릭대학교 의과대학 영상의학과) ;
  • 안국진 (가톨릭대학교 의과대학 영상의학과) ;
  • 최현석 (가톨릭대학교 의과대학 영상의학과) ;
  • 정소령 (가톨릭대학교 의과대학 영상의학과) ;
  • 이윤주 (가톨릭대학교 의과대학 영상의학과) ;
  • 김범수 (가톨릭대학교 의과대학 영상의학과)
  • Received : 2011.07.27
  • Accepted : 2011.08.30
  • Published : 2011.08.31
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Abstract

Purpose : To retrospectively evaluate the usefulness of diffusion-weighted images, ADC maps and conventional MR images for determination of brain tumor consistency. Materials and Methods : Twenty-three patients with brain tumor underwent MR examinations with T1, T2 and diffusion-weighted images. Regions of interest (ROIs) were drawn in the tumors, and the measured signal intensities (SI) were normalized with the contralateral side. We evaluated the correlation between SI ratios from various images and tumor consistency assessed at surgery. In three patients with both cystic and solid components, each component was evaluated independently. Qualitatively observed SIs were also correlated with tumor consistency. Results : Statistical analysis revealed significant correlation between tumor consistency and ADC ratio (r = -0.586, p = 0.002), SI ratios on T2-weighted images (r = -0.497, p = 0.010), and observed SIs on T2-weighted images (r = -0.461, p = 0.018). The relative ratio of ADC value correlated with tumor consistency most strongly. Conclusion : The measured ratio of ADC, SI ratio and observed SI grade on T2-weighted images can provide valuable information about the consistency of brain tumor.

목적 : 수술 전 축내 뇌종양의 경도를 평가하는데 확산강조영상 및 현성확산계수영상과 고식적 MR 영상의 유용성을 알아보고자 하였다. 대상 및 방법: 축내 뇌종양으로 수술을 받은 23명의 환자를 대상으로 T1, T2, 확산강조영상 소견을 후향적으로 분석하였다. 다양한 MR영상에서의 신호강도와 수술에서 평가한 종양의 경도를 정량적, 정성적으로 비교 분석하였다. 수술소견에서 종양의 경도는 낭성, 젤리같은, 쉽게 부서지는, 부드러운, 단단한, 딱딱한 정도로 나눴다. 세 명의 환자에서는 낭성 부분과 고형성 부분이 함께 있어서 각각에 대해서 평가하였다. 결과: 종양이 단단할수록 현성확산계수와 T2강조영상에서의 신호강도의 비는 더 낮았다 (p = 0.002, p = 0.01). 종양의 경도와 현성확산계수가 가장 강한 선형상관관계를 보였다 (r = -0.586, p = 0.002). 정성적 분석에서는 단단할수록 T2강조영상에서 정성적 신호강도 등급이 낮았다 (p = 0.018). 그 외 다른 MR소견은 통계분석에서 종 양의 경도와 유의한 상관관계를 보이지 않았다. 결론: 축내 뇌종양의 현성확산계수, T2강조영상에서 신호강도의 비와 정성적 신호강도 등급은 종양의 경도와 상관관계가 있었고 이는 수술 전 전략 수립에 많은 도움이 될 것으로 생각된다.

Keywords

References

  1. Iuchi T, Saeki N, Tanaka M, Sunami K, Yamaura A. MRI prediction of fibrous pituitary adenomas. Acta Neurochir (Wien) 1998;140:779-786 https://doi.org/10.1007/s007010050179
  2. Snow RB, Johnson CE, Morgello S, Lavyne MH, Patterson RH, Jr. Is magnetic resonance imaging useful in guiding the operative approach to large pituitary tumors? Neurosurgery 1990;26:801-803 https://doi.org/10.1227/00006123-199005000-00011
  3. Naganuma H, Satoh E, Nukui H. Technical considerations of transsphenoidal removal of fibrous pituitary adenomas and evaluation of collagen content and subtype in the adenomas. Neurol Med Chir (Tokyo) 2002;42:202-212; discussion 213 https://doi.org/10.2176/nmc.42.202
  4. Bahuleyan B, Raghuram L, Rajshekhar V, Chacko AG. To assess the ability of MRI to predict consistency of pituitary macroadenomas. Br J Neurosurg 2006;20:324-326 https://doi.org/10.1080/02688690601000717
  5. Chakrabortty S, Oi S, Yamaguchi M, Tamaki N, Matsumoto S. Growth hormone-producing pituitary adenomas: MR characteristics and pre- and postoperative evaluation. Neurol Med Chir (Tokyo) 1993;33:81-85 https://doi.org/10.2176/nmc.33.81
  6. Hagiwara A, Inoue Y, Wakasa K, Haba T, Tashiro T, Miyamoto T. Comparison of growth hormone-producing and non-growth hormone-producing pituitary adenomas: imaging characteristics and pathologic correlation. Radiology 2003;228:533-538 https://doi.org/10.1148/radiol.2282020695
  7. Yamaguchi N, Kawase T, Sagoh M, Ohira T, Shiga H, Toya S. Prediction of consistency of meningiomas with preoperative magnetic resonance imaging. Surg Neurol 1997;48:579-583 https://doi.org/10.1016/S0090-3019(96)00439-9
  8. Suzuki Y, Sugimoto T, Shibuya M, Sugita K, Patel SJ. Meningiomas: correlation between MRI characteristics and operative findings including consistency. Acta Neurochir (Wien) 1994;129:39-46 https://doi.org/10.1007/BF01400871
  9. Maiuri F, Iaconetta G, de Divitiis O, Cirillo S, Di Salle F, De Caro ML. Intracranial meningiomas: correlations between MR imaging and histology. Eur J Radiol 1999;31:69-75 https://doi.org/10.1016/S0720-048X(98)00083-7
  10. Yrjana SK, Tuominen H, Karttunen A, Lahdesluoma N, Heikkinen E, Koivukangas J. Low-field MR imaging of meningiomas including dynamic contrast enhancement study: evaluation of surgical and histopathologic characteristics. AJNR Am J Neuroradiol 2006;27:2128-2134
  11. Kashimura H, Inoue T, Ogasawara K, et al. Prediction of meningioma consistency using fractional anisotropy value measured by magnetic resonance imaging. J Neurosurg 2007;107:784-787 https://doi.org/10.3171/JNS-07/10/0784
  12. Pierallini A, Caramia F, Falcone C, et al. Pituitary macroadenomas: preoperative evaluation of consistency with diffusionweighted MR imaging--initial experience. Radiology 2006;239:223-231 https://doi.org/10.1148/radiol.2383042204
  13. Suzuki C, Maeda M, Hori K, et al. Apparent diffusion coefficient of pituitary macroadenoma evaluated with line-scan diffusion-weighted imaging. J Neuroradiol 2007;34:228-235 https://doi.org/10.1016/j.neurad.2007.06.007
  14. Mahmoud OM, Tominaga A, Amatya VJ, et al. Role of PROPELLER diffusion-weighted imaging and apparent diffusion coefficient in the evaluation of pituitary adenomas. Eur J Radiol 2010.(Epub ahead of print)
  15. Kono K, Inoue Y, Nakayama K, et al. The role of diffusionweighted imaging in patients with brain tumors. AJNR Am J Neuroradiol 2001;22:1081-1088
  16. Guo AC, Cummings TJ, Dash RC, Provenzale JM. Lymphomas and high-grade astrocytomas: comparison of water diffusibility and histologic characteristics. Radiology 2002;224:177-183 https://doi.org/10.1148/radiol.2241010637
  17. Gudbjartsson H, Maier SE, Mulkern RV, Morocz IA, Patz S, Jolesz FA. Line scan diffusion imaging. Magn Reson Med 1996;36:509-519 https://doi.org/10.1002/mrm.1910360403
  18. Pipe JG, Farthing VG, Forbes KP. Multishot diffusion-weighted FSE using PROPELLER MRI. Magn Reson Med 2002;47:42-52 https://doi.org/10.1002/mrm.10014