Publikationsserver der Universitätsbibliothek Marburg
Titel:Staging des Rektumkarzinoms mit Hilfe diffusionsgewichteter MRT-Sequenzen - Erste Ergebnisse der StaRdusT-Studie
Autor:Funk, Annika Barbara
Weitere Beteiligte: Heverhagen, Johannes T. (Prof. Dr. Dr.)
Veröffentlicht:2015
URI:https://archiv.ub.uni-marburg.de/diss/z2015/0136
DOI: https://doi.org/10.17192/z2015.0136
URN: urn:nbn:de:hebis:04-z2015-01361
DDC: Medizin
Titel (trans.):Staging of rectal carcinoma with diffusion weighted imaging - Preliminary results of the StaRdusT-study
Publikationsdatum:2015-02-23
Lizenz:https://rightsstatements.org/vocab/InC-NC/1.0/

Dokument

Schlagwörter:
Kernspintomographie, colorectal carcinoma, diffusion, DWI, Mastdarmkrebs, diffusion weighted imaging, Kolorektales Karzinom, Rektumkarzinom, Diffusion, rectal carcinoma, Dickdarmkrebs, MRT, MRI

Zusammenfassung:
Die vorliegende Studie beschreibt erste Ergebnisse aus der Studie „StaRdusT - Staging des Rektumkarzinoms in der MRT mit Hilfe von diffusionsgewichteten MRT-Sequenzen“. Das Ziel dieser ist das Staging des primären Rektumkarzi-noms mittels diffusionsgewichteter MRT (DWI-MRT) und dabei insbesondere die Darstellung und Beurteilung von Lymphknoten. Dazu wurden 17 Patienten mittels 1.5T-MRT (± neoadjuvante Therapie) unter-sucht, operiert und die Operationsresektate histologisch untersucht. Die Bildge-bung erfolgte mittels T1- und T2-gewichteter MRT analog zum MERCURY-Protokoll und zusätzlicher diffusionsgewichteter Sequenzen (b 0, 500, 800). Zwei unabhängige Untersucher beurteilten die Signalintensität der Tumore und der einzelnen Lymphknoten und maßen die Apparent Diffusion Coeffizienten (ADC-Wert) in der korrespondieren ADC-Map. Die mittleren ADC-Werte der Tumoren und Lymphknoten wurden auf Unterschiede in Abhängigkeit von der Durchführung einer neoadjuvanten Therapie (+/- neoadjuvante Therapie), MRT-Parametern (T-, N-, M-Stadium) und histologischen Parametern (positi-ver/negativer Lymphknotenstatus, histologischer Differenzierungsgrad) unter-sucht. Es zeigten sich signifikante Unterschiede zwischen den mittleren Tumor-ADC-Werten der Gruppen mit negativem und positivem Lymphknotenstatus (1.134 ± 0.2 x 10-3 mm2/s vs. 1.241 ± 0.2 x 10-3 mm2/s; p = 0.001). Es konnten keine sig-nifikanten mittleren ADC-Wert-Unterschiede der Tumore in Abhängigkeit von T-Stadium, M-Stadium, +/- neoadjuvanter Therapie oder histologischen Differen-zierungsgrad beobachtet werden. Niedrigere ADC-Werte waren allerdings mit einem aggressiveren Tumorprofil (positiver Lymphknotenstatus, T3-4-Stadium M1-Stadium) assoziiert. Die mittleren Lymphknoten-ADC-Werte unterschieden sich signifikant zwischen den Gruppen mit und ohne neoadjuvanter Therapie (0.773 ± 0.4 x 10-3 mm2/s vs. 1.292 ± 0.5 x 10-3 mm2/s; p = 0.025). Innerhalb der Gruppe ohne neoadjuvante Therapie zeigten Metastasen höhere ADC-Werte als benigne Lymphknoten (0.958 ± 0.4 x 10-3 mm2/s vs. 0.786 ± 0.3 x 10-3 mm2/s; p = 0.017). Nach neoadjuvanter Therapie zeigten Metastasen signifikant niedrigere ADC-Werte im Vergleich zu benignen Lymphknoten (0.731 ± 0.3 x 10-3 mm2/s vs. 1.067 ± 0.4 x 10-3 mm2/s; p = 0.004). Mit einem ADC-Cut-off-Wert von 1.3 x 10-3 mm2/s bzw. 0.5 x 10-3 mm2/s zeigte die DWI für die Diffe-renzierung von Lymphknotenmetastasen eine Sensitivität/Spezifität/PPW/NPW von entsprechend 100%/75%/75%/100% und 100%/75%/50%/100% in den Gruppen ohne und mit neoadjuvanter Therapie. Wurde nur die Signalintensität in der DWI berücksichtigt, so erreichte die DWI über die gesamte Studienpopu-lation hinweg eine Sensitivität/Spezifität/PPW/NPW von entsprechend 100%/0%/29%/0%. Es konnten keinen signifikanten Unterschiede in den mittle-ren Lymphknoten-ADC-Werten in Abhängigkeit vom T-Stadium, M-Stadium o-der histologischem Differenzierungsgrad beobachtet werden. Ein niedriger ADC-Wert eines Tumors scheint demnach mit einem aggressiven Tumorprofil assoziiert. Bei Patienten ohne Vorbehandlung spiegeln hohe ADC-Werte Nekroseherde innerhalb der Lymphknoten wider. Nach neoadjuvanter Therapie kann ein niedriger ADC-Wert –je nach Durchführungszeitpunkt der MRT nach Therapiebeginn- mit einer Zellschwellung, Fibrose oder vitalem Tu-morwachstum assoziiert sein. Auch benigne Lymphknoten können hohe ADC-Werte und einen großen Durchmesser erreichen. Dies scheint unspezifische zelluläre Reaktionen, wie z.B. ein Ödem, zu reflektieren. Die Hinzunahme von ADC-Werten zur Beurteilung der Lymphknoten in der DWI verbessert die diag-nostische Genauigkeit dieser Bildgebung im Vergleich zur Beurteilung mittels Signalintensität alleine. Da sich die ADC-Werte benigner und maligner Lymph-knoten stark überschneiden, sollte für die Lymphknotenbeurteilung beim Rek-tumkarzinom die DWI mit der T2w-MRT kombiniert werden.

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