{"id":5096,"date":"2015-12-18T09:58:34","date_gmt":"2015-12-18T09:58:34","guid":{"rendered":"https:\/\/jurmed.ro\/medici\/?p=5096"},"modified":"2016-01-15T13:03:28","modified_gmt":"2016-01-15T13:03:28","slug":"irm-in-patologia-ginecologica","status":"publish","type":"post","link":"https:\/\/jurmed.ro\/medici\/irm-in-patologia-ginecologica\/","title":{"rendered":"IRM \u00een patologia ginecologic\u0103"},"content":{"rendered":"

Examinarea prin rezonan\u021b\u0103 magnetic\u0103 permite identificarea originii \u00een cazul tumorilor pelvine, inclusiv a celor insuficient caracterizate ecografic. \u00cen cazul chistelor, dermoide, endometrioamelor sau fibroamelor uterine (cele mai frecvente patologii care mimeaz\u0103 ecografic patologia malign\u0103) IRM permite, prin detec\u021bia componentelor gr\u0103soase, sangvine sau fibroase intratumorale, un diagnostic de \u00eencredere.<\/p>\n

\u00cen cazul leziunilor chistice solide anexiale la pacientele tinere cu\u00a0markeri tumorali u\u0219or crescu\u021bi cu aspect ,,borderline\u201d (cu\u00a0suprapuneri ale caracterelor de benignitate-malignitate) IRM pelvin\u00a0aduce informatii suplimentare, utile chirurgului \u00een planificarea unei\u00a0interven\u021bii conservative sau radicale \u0219i \u00een selec\u021bia preoperatorie a\u00a0pacientelor potrivite pentru laparoscopie vs laparotomie. IRM este util\u0103 \u00een identificarea cazurilor \u00een care se pot evita proceduri chirurgicale extensive.<\/p>\n

\u00cen caracterizarea patologiei ginecologice, IRM func\u021bional, prin secven\u021bele DWI (Diffusion Weighted Imaging) \u0219i DCE (Dynamic Contrast Enhanced), permite detectarea tumorilor cu volum mic \u0219i a recuren\u021belor timpurii, care nu prezint\u0103 modific\u0103ri morfologice detectabile pe secven\u021bele conven\u021bionale.<\/p>\n

DWI (Diffusion Weighted Imaging) – tehnic\u0103 func\u021bional\u0103 recent\u0103 IRM, care ofer\u0103 informa\u021bii despre celularitatea \u021besuturilor \u0219i despre integritatea membranelor celulare, joac\u0103 azi un rol din ce \u00een ce mai important \u00een imagistica oncologic\u0103. DWI investigheaz\u0103 difuzia apei la nivel celular, oferind informa\u021bii func\u0163ionale esen\u021biale despre \u021besuturi. DWI caracterizeaz\u0103 leziunile infracentimetrice \u0219i modific\u0103rile intraparenchimatoase, \u00eenainte ca acestea s\u0103 fie vizibile \u00een secven\u0163ele conven\u0163ionale (morfologice).
\nDWI ofer\u0103 evalu\u0103ri calitative \u015fi cantitative \u2013 coeficientul aparent de difuzie (ADC) \u2013 utile \u00een diagnosticul diferen\u0163ial al leziunilor intraparenchimatoase. \u00cen compara\u021bie cu un chist, o tumor\u0103 va prezenta pe imaginile DWI o restric\u021bie de difuzie mai mare, deoarece membranele intacte ale celulelor tumorale \u00eempiedic\u0103 mi\u0219carea liber\u0103 a moleculelor de ap\u0103. Pe har\u021bile ADC, tumorile prezint\u0103 valori sc\u0103zute ale coeficientului \u0219i se eviden\u021biaz\u0103 ca arii de intensitate mai sc\u0103zut\u0103 a semnalului comparativ cu \u021besuturile normale.Valorile cantitative ale ADC pot ajuta la caracterizarea leziunilor \u0219i au aplica\u021bii \u00een evaluarea r\u0103spunsului la terapie. H\u0103r\u021bile ADC \u0219i imaginile DWI trebuie interpretate \u00eentotdeuna \u00een corela\u021bie cu imaginile anatomice IRM conven\u021bionale. Fuziunea dintre imaginile DWI si T2-WI este capabil\u0103 s\u0103 caracterizeze at\u00e2t tumorile maligne c\u00e2t \u0219i rela\u021biile anatomice de vecin\u0103tate.
\nDWI – \u00een tumorile maligne cu celularitate sc\u0103zut\u0103 precum adenocarcinoamele \u0219i cancerele ovariene cu component\u0103 chistic\u0103, sau \u00een tumorile cu zone necrotice, restric\u021bia de difuzie este mult mai limitat\u0103 \u0219i, \u00een consecin\u021b\u0103, nu este eviden\u021biat\u0103 pe imaginile DWI. Din acest motiv, DWI nu este recomandat\u0103 \u00een caracterizarea leziunilor ovariene.<\/p>\n

DWI- rezultate fals pozitive: endometrul normal, nodulii limfatici reactivi \u0219i mucoasa intestinal\u0103 cu densitate celular\u0103 ridicat\u0103 sunt \u0219i ele hiperintense pe imaginile DWI. Diferen\u021bierea se poate face pe har\u021bile ADC, deoarece tumorile prezint\u0103 valori ale ADC semnificativ sc\u0103zute.<\/p>\n

DCE (Dynamic Contrast Enhanced) implic\u0103 achizi\u021bia de imagini secven\u021biale \u00een timpul trecerii agentului de contrast prin \u021besuturile de interes. Intensitatea capt\u0103rii agentului de contrast este corelat\u0103 cu densitatea vascular\u0103 din \u021besut, \u00een timp ce rata \u0219i wash-out-ul agentului de contrast este corelat\u0103 cu factori angiogenici precum densitatea capilar\u0103 \u0219i factorul de cre\u0219tere vascular\u0103 endotelial\u0103. Oferind informa\u021bii despre perfuzia tumoral\u0103 \u0219i permeabilitatea capilar\u0103, DCE are capacitatea de a caracteriza noninvaziv vasculariza\u021bia \u021besutului tumoral, inclusiv r\u0103spunsul la terapia antiangiogenic\u0103.
\n\u00cen evaluarea tumorilor de col uterin, DCE poate detecta tumorile mici cu invazie stromal\u0103 \u00eentre 3-5 mm \u0219i face diferen\u021bierea \u00eentre tumorile recurente \u0219i fibrozele post-iradiere.<\/p>\n

Aplica\u021bii investiga\u021biei IRM \u00een patologia ginecologic\u0103:<\/span><\/strong>
\nStadializarea neoplasmelor ginecologice:<\/strong>
\nIRM reprezint\u0103 investiga\u021bia imagistic\u0103 de prim\u0103 linie \u00een stadializarea cancerului cervical (invazie parametrial\u0103 \u2013 acurate\u021be \u00eentre 77 si 96%) \u0219i endometrial (invazie miometrial\u0103 – acurate\u021be de 83-92%, senzitivitate de 87% si specificitate de 91% \u0219i invazie cervical\u0103 \u2013 80% senzitivitate \u0219i 96% specificitate) \u0219i \u00een caracterizarea maselor anexiale. Pentru detectarea invaziei vezicale \u0219i a implic\u0103rii vaginale este recomandat\u0103 folosirea gelului endovaginal.<\/p>\n

Ghidarea tratamentului:<\/strong>
\n\u2022 chirurgical versus radioterapie \u00een cancerul cervical;
\n\u2022 histerectomie radical\u0103 \u0219i limfadenectomie versus histerectomie simpl\u0103 \u00een cancerul endometrial.<\/p>\n

Detec\u021bia recuren\u021belor:<\/strong> rezolu\u021bia de contrastul tisular superior al IRM permite detec\u021bia precoce a bolii pelvine localizate.<\/p>\n

\n

Cristina MAIER
\nMEDINST Diagnostic
\nRom\u00e2no-German<\/p>\n

\"MADinst\"<\/a><\/p>\n

\n

Medinst Diagnostic Rom\u00e2no-German func\u021bioneaz\u0103 din anul 1997 \u00een cadrul Institutului Na\u021bional de Neurologie \u0219i Boli Neurovasculare Bucure\u0219ti.<\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"

Examinarea prin rezonan\u021b\u0103 magnetic\u0103 permite identificarea originii \u00een cazul tumorilor pelvine, inclusiv a celor insuficient caracterizate ecografic. \u00cen cazul chistelor, dermoide, endometrioamelor sau fibroamelor uterine (cele mai frecvente patologii care […]<\/p>\n","protected":false},"author":6,"featured_media":5150,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[33,429],"tags":[442],"class_list":["post-5096","post","type-post","status-publish","format-standard","has-post-thumbnail","category-articole","category-ginecologie","tag-medinst"],"yoast_head":"\nIRM \u00een patologia ginecologic\u0103 - Jurmed - Medici<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/jurmed.ro\/medici\/irm-in-patologia-ginecologica\/\" \/>\n<meta property=\"og:locale\" content=\"ro_RO\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"IRM \u00een patologia ginecologic\u0103 - 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