Naslov (srp)

Značaj volumetrijske i histogramske analize parametara dobijenih magnetno-rezonantnim pregledom u proceni i predviđanju odgovora karcinoma rektuma na neoadjuvantnu hemioradioterapiju : doktorska disertacija

Autor

Janković, Aleksandra, 1984-

Doprinosi

Marković, Velimir, 1959-
Đurić-Stefanović, Aleksandra, 1968-
Stojanović, Sanja, 1965-
Kovač, Jelena, 1978-
Barišić, Goran, 1965-

Opis (eng)

BACKGROUND: Colorectal cancer, i.e. cancer of the colon and/or rectum, represents a significant public health problem, given that globally it is the third most frequently diagnosed and the second most fatal cancer, with about a third of cases being located in the rectum. In 2020, of all cancer-related deaths, 9.4% were caused by colorectal cancer. However, due to the increasingly pronounced aging of the population, as well as the increase in the number of newly discovered cases in it, it is estimated that the global incidence will more than double by 2035. Determination of tumor stage is the most important predictor of clinical outcome in patients with rectal cancer, where histopathological (HP) analysis of the preparation plays an irreplaceable role in determining the depth of tumor invasion (T) as well as the involvement of lymph nodes (N). Determining the local stage of rectal cancer has progressed significantly in recent decades, and today it relies to the greatest extent on the magnetic-resonance (MR) examination of the rectum, which is considered extremely reliable. Advanced MR techniques, although not yet an integral part of the standard MR examination, constitute significant additional tools with great potential for use in the diagnosis of rectal cancer. A very sophisticated MR approaches are volumetric and histogram analysis, which have a significant potential in evaluating and predicting the response to applied therapy.AIM: The aim of this study is to determine the diagnostic accuracy of certain morphological parameters of MR examination for predicting the response to neoadjuvant chemoradiotherapy (nHRT) in patients with rectal cancer in correlation with HP findings as a gold standard, as well as to examine the value of histogram and volumetric analysis of morphological and functional parameters MR examinations determined before and after therapy to evaluate and predict outcome after neoadjuvant chemoradiotherapy.MATERIALS AND METHODS: The research was conducted according to the type of cohort study at the Department of Digestive Radiology, Center for Radiology, University Clinical Center of Serbia, in the period from the beginning of 2020. to August 2023. The study included patients with histopathologically confirmed locally advanced rectal cancer. After HP verification, all patients had an initial MR examination, while a control MR examination was performed after the completion of nCRT. HP findings are considered the gold standard for assessing the diagnostic accuracy of MR examination methods. The following parameters were analyzed: tumor localization, craniocaudal tumor diameter, presence of extramural tumor propagation, lymphnodal status, assessment of tumor infiltration of the mesorectal fascia (MRF), assessment of extramural vascular invasion according to Smith, local tumor stage before and after therapy. Tumor characteristics, MRI-estimated grade of tumor regression (mrTRG), grade of pathologic tumor regression (pTRG), volumetry and histogram analysis were assessed both at baseline and at follow-up. All patients were classified into responders and non-responders according to the degree of pathological tumor regression.RESULTS: The degree of tumor regression determined by MR examination (mrTRG) represents a good measure of diagnostic accuracy, with a sensitivity of 50% and a specificity of 85.7%. The diagnostic performance of T stage tumors after applied nCRT on MR examination in terms of sensitivity, specificity, PPV and NPV were 82.4%, 87.0%, 66.7% and 94.0%, while the diagnostic performance of N stage tumors after applied completed therapy on MR examination in terms of sensitivity, specificity, PPV and NPV were 75.0%, 89.4%, 78.3% and 87.5%. There is a significant difference in kurtosis values after applied nCRT compared to the studied groups, whereby responders had statistically significantly higher kurtosis valuesafter applied nCRT compared to non-responders (p=0.024). There is a significant difference in volume after applied nCRT compared to the examined groups, whereby responders had a statistically significantly lower volume after applied nCRT compared to non-responders (p=0.019)...

Opis (srp)

UVOD: Kolorektalni karcinom, odnosno karcinom kolona i/ili rektuma, predstavlja značajan javno-zdravstveni problem s obzirom da globalno zauzima treće mesto najčešće dijagnostikovanih, a drugo mesto najfatalnijih karcinoma, pri čemu je oko trećina slučajeva locirana u rektumu. U 2020. godini, od svih smrti povezanih sa karcinomima, 9,4% je bilo prouzrokovano kolorektalnim karcinomom. Međutim, zbog sve izraženijeg starenja populacije, kao i povećanja broja novooktrivenih slučajeva u istoj, procenjuje se da će se globalna incidencija više nego udvostručiti do 2035. godine. Određivanje stadijuma tumora predstavlja najvažniji prediktor kliničkog ishoda kod obolelih od karcinoma rektuma, pri čemu histopatološka (HP) analiza preparata ima nezamenljivu ulogu u određivanju dubine tumorske invazije (T) kao i zahvaćenosti limfnih nodusa (N). Određivanje lokalnog stadijuma karcinoma rektuma je značajno napredovalo poslednjih decenija i danas se u najvećoj meri oslanja na magnetno-rezonantni (MR) pregled rektuma koji se smatra izuzetno pouzdanim. Napredne MR tehnike, iako još uvek nisu sastavni deo standardnog pregleda čine značajne dodatne alatke sa velikim potencijalom za upotrebu u dijagnostici karcinoma rektuma. Neke od naprednih MR tehnika su volumetrijska i histogramska analiza, koje bi mogle imati velike mogućnosti u proceni i predviđanju odgovora na primenjenu terapiju. CILJ: Cilj ove studije je da se utvrdi dijagnostička tačnost pojedinih morfoloških parametara MR pregleda za procenu i predviđanje odgovora na neoadjuvantnu hemioraditerapiju (nHRT) kod pacijenata sa karcinomom rektuma u korelaciji sa HP nalazom kao zlatnim standardom, kao i da se ispita značaj histogramske i volumetrijske analize parametara MR pregleda određenih pre i posle terapije. MATERIJAL I METODE: Istraživanje je sprovedeno po tipu kohortne studije u Odseku digestivne radiologije Centra za radiologiju, Univerzitetskog kliničkog centra Srbije, u periodu od početka 2020. do avgusta 2023. U studiju su uključeni pacijenti sa lokalno uznapredovalim karcinomom rektuma. Nakon HP verifikacije karcinoma, svim pacijentima rađen je inicijalni MR pregled, dok je kontrolni MR pregled učinjen nakon završetka nHRT. HP nalaz smatran je zlatnim standardom za procenu dijagnostiče tačnosti pojedinih parametara MR pregleda. Analizirani su sledeći parametri: lokalizacija tumora, kraniokaudalni dijametar tumora, prisustvo ekstramuralne propagacije tumora, limfonodalni status, procena tumorske infiltracije mezorektalne fascije (MRF), procena ekstramuralne vaskularne invazije (EMVI) po Smithu, lokalni stadijum tumora pre i nakon nHRT kao i T2-weighted volumetrijski i histogramski parametri. Svi pacijenti su klasifikovani u respondere i ne-respondere prema stepenu patološke regresije tumora.REZULTATI: Stepen regresije tumora utvrđen MR pregledom (mrTRG) predstavlja dobru meru dijagnostičke tačnosti, sa senzitivnošću od 50% i specifičnošću od 85,7%. Dijagnostičke performanse T stadijuma tumora nakon primenjene HRT na MR pregledu u smislu senzitivnosti, specifičnosti, PPV i NPV bile su 82,4%, 87,0%, 66,7% i 94,0%, dok su dijagnostičke performanse N stadijuma tumora nakon primenjene HRT na MR pregledu u smislu senzitivnosti, specifičnosti, PPV i NPV bile su 75,0%, 89,4%, 78,3% i 87,5%. Postoji značajna razlika u vrednostima kurtozisa nakon primenjene nHRT u odnosu na ispitivane grupe, pri čemu su responderi imali statistički značajno više vrednosti kurtozisa nakon u odnosu na ne-respondere (p=0,024). Postoji značajna razlika u volumenu nakon primenjene nHRT u odnosu na ispitivane grupe, pri čemu su responderi imali statistički značajno niži volumen u odnosu na ne-respondere (p=0.019)...

Opis (srp)

Medicina - Radiologija i nuklearna medicina / Medicine - Radiology and nuclear medicine Datum odbrane: 30.09.2024.

Jezik

srpski

Datum

2024

Licenca

Ovo delo je licencirano pod uslovima licence
Creative Commons CC BY-NC 3.0 AT - Creative Commons Autorstvo - Nekomercijalno 3.0 Austria License.

http://creativecommons.org/licenses/by-nc/3.0/at/legalcode

Predmet

OSNO - Opšta sistematizacija naučnih oblasti, Biomedicinska tehnika. Nuklearna medicina

magnetna rezonanca (MR), neoadjuvantna hemioradioterapija (nHRT), rektalni karcinom, volumetrija, histogramska analiza

615.849:616.35-006.6(043.3)

OSNO - Opšta sistematizacija naučnih oblasti, Biomedicinska tehnika. Nuklearna medicina

magnetic resonance (MR), neoadjuvant chemoradiotherapy, rectal cancer, volumetry, histogram analysis