{"id":5121,"date":"2015-12-18T11:21:48","date_gmt":"2015-12-18T11:21:48","guid":{"rendered":"https:\/\/jurmed.ro\/medici\/?p=5121"},"modified":"2016-01-15T12:58:44","modified_gmt":"2016-01-15T12:58:44","slug":"irm-si-ct-in-patologia-oncologica","status":"publish","type":"post","link":"https:\/\/jurmed.ro\/medici\/irm-si-ct-in-patologia-oncologica\/","title":{"rendered":"IRM \u015fi CT \u00een patologia oncologic\u0103"},"content":{"rendered":"

A. IRM \u00een patologia abdomino-pelvin\u0103<\/strong><\/span><\/p>\n

I. IRM hepato-bilio-pancreatic<\/strong><\/p>\n

Aplica\u021biile IRM \u00een patologia hepatic\u0103:<\/span><\/strong>
\n\u2022 depisteaz\u0103 \u0219i caracterizeaz\u0103 leziunile focale solide intrahepatice: leziuni primare (hiperplazia focal\u0103 nodular\u0103, adenom, hepatocarcinom, colangiocarcinom intrahepatic etc.) \u0219i leziuni secundare (metastaze cu diferite puncte de plecare);
\n\u2022 este util\u0103 \u00een evaluarea ficatului cirotic (aprecieri morfologice asupra ficatului);
\n\u2022 diferen\u021biaz\u0103 nodulii regenerativi hepatici de nodulii displazici;
\n\u2022 caracterizeaz\u0103, \u00een patologia hepatic\u0103 difuz\u0103, steatoza hepatic\u0103, hemosideroza \u0219i hemocromatoza;
\n\u2022 diferen\u021biaz\u0103 leziunile chistice hepatice: chiste simple, abcese, hamartoame biliare, determin\u0103ri secundare chistice;
\n\u2022 caracterizeaz\u0103 leziuni hepatice vasculare: \u0219unturi arterio-venoase, sindrom Budd Chiari, patologia venei porte.<\/p>\n

Aplica\u021biile IRM \u00een patologia pancreatico-biliar\u0103:<\/strong><\/span>
\n\u00cen patologia tumoral\u0103 pancreatic\u0103:
\n\u2022 aduce informa\u021bii suplimentare \u00een diagnosticul diferen\u021bial de pancreatit\u0103 cronic\u0103 pseudotumoral\u0103 vs neoplasm pancreatic (tumori mucinoase papilare intraductale, adenocarcinoame pancreatice);
\n\u2022 este util\u0103 pentru monitorizarea pacientilor trata\u021bi pentru neoplasme pancreatice;
\n\u2022 util\u0103 pentru detec\u021bia precoce a recidivei tumorale, a extensiei locoregionale sau la distan\u021b\u0103;
\n\u00cen patologia malformativ\u0103 a pancreasului \u0219i a c\u0103ilor biliare hepatice \u0219i extrahepatice;
\n\u00cen patologia inflamatorie de tip colangitic;
\n\u00cen cazul obstruc\u021biilor biliare, pentru determinarea naturii obstacolului, a
\nlocaliz\u0103rii \u0219i a aspectului arborelui biliar \u00een aval \u0219i amonte de obstacol.<\/p>\n

Secven\u021ba colangiopancreatografie IRM (MRCP):<\/strong><\/span><\/p>\n

ColangioRM este tehnica neinvaziv\u0103 de elec\u021bie \u00een explorarea arborelui biliar (intra- \u0219i extrahepatic) \u0219i a ductului pancreatic;
\n\u2022 este superior CT \u00een evaluarea neoplasmelor pancreatice chistice, deoarece eviden\u021biaz\u0103 prezen\u021ba\/absen\u021ba comunic\u0103rii cu ductul pancreatic principal;
\n\u2022 este util\u0103 \u00een alegerea tratamentului specific fiec\u0103rui tip de tumor\u0103 \u00een parte; rezultatele ob\u021binute sunt comparabile cu ERCP (tehnic\u0103 invaziv\u0103 cu rezolutie spa\u021bial\u0103 \u00eenalt\u0103).
\nAvantajele colangiopancreatografiei IRM fata de ERCP:
\n\u2022 tehnic\u0103 neinvaziv\u0103 (far\u0103 manipulare endoscopic\u0103),
\n\u2022 neiradiant\u0103, f\u0103r\u0103 substan\u021b\u0103 de contrast,
\n\u2022 f\u0103r\u0103 complica\u021bii iatrogene (post ERCP risc de 5%, de ex. pancreatit\u0103).
\nII. IRM \u00een patologia splenic\u0103<\/strong>
\nLeziunile splenice sunt descoperite incidental \u00een cadrul unei explor\u0103ri IRM abdominale sau sunt descoperite
\necografic sau tomografic \u0219i trimise pentru evaluare superioar\u0103 prin rezonan\u021b\u0103 magnetic\u0103.<\/p>\n

III. IRM \u00een patologia suprarenal\u0103<\/strong>
\nRezonan\u021ba magnetic\u0103 aduce informa\u021bii superioare celor ob\u021binute prin tomografie computerizat\u0103: diferen\u021biaz\u0103
\nmai u\u0219or dec\u00e2t CT leziunile benigne suprarenaliene (adenom) de cele maligne primare sau secundare.
\nDepisteaz\u0103 gr\u0103simea intralezional\u0103, tipic\u0103 pentru adenom, prin folosirea secven\u021belor \u00een pondera\u021bie T1 (in
\nphase\/out of phase). De multe ori nu mai este nevoie de administrarea substan\u021bei de contrast i.v.<\/p>\n

IV. IRM \u0219i CT \u00een patologia renal\u0103<\/strong>
\nSunt metode neinvazive de vizualizare a \u00eentregului aparat excretor (rinichi, uretere, vezic\u0103 urinar\u0103). At\u00e2t IRM c\u00e2t \u0219i CT pot caracteriza corespunz\u0103tor patologia tumoral\u0103 \u0219i infec\u021bioas\u0103 renal\u0103. Odat\u0103 cu introducerea urografiei RM se poate evalua \u0219i patologia sistemului excretor renal. CT este superioar\u0103 IRM \u00een depistarea litiazei renale \u0219i ureterale.<\/p>\n

Aplica\u021bii ale UroIRM:<\/strong><\/span>
\n\u2022 \u00een caracterizarea unor leziuni cu caracter incert la CT: leziuni mici (sub 1 cm) a c\u0103ror iodofilie este dificil de apreciat tomografic,
\n\u2022 \u00een diferen\u021bierea unui chist cu complica\u021bii (hemoragice, infec\u021bioase) de o leziune solid\u0103 renal\u0103,
\n\u2022 permite o analiz\u0103 morfologic\u0103 \u0219i func\u021bional\u0103 net superioar\u0103 urografiei conven\u021bionale;
\nIndica\u021bii: hidronefroze congenitale, forma\u021biuni tumorale, malforma\u021bii, calculi, stenoze.<\/p>\n

V. IRM prostat\u0103<\/strong>
\nProstata prezint\u0103 de multe ori la v\u00e2rstnici un aspect heterogen al glandei centrale (datorit\u0103 hiperplaziei benigne \u0219i\/sau modific\u0103rilor inflamatorii) care face dificil\u0103 detec\u021bia precoce a leziunilor maligne prin examinarea ecografic\u0103.IRM aduce informa\u021bii suplimentare ecografiei prin capacitatea excelent\u0103 de vizualizare a arhitecturii zonale prostatice \u0219i a leziunilor de mici dimensiuni.<\/p>\n

Protocoale IRM de prostat\u0103 multiparametrice permit evaluarea:<\/strong><\/span>
\n\u2022 morfologiei (imagini T2 ponderate),
\n\u2022 perfuziei lezionale (IRM cu contrast dinamic),
\n\u2022 densit\u0103\u021bii tisulare (difuzia RM cu evaluarea h\u0103rtii ADC),
\n\u2022 metabolismului (spectroscopia RM).<\/p>\n

IRM permite caracterizarea de fine\u021be a leziunilor prostatice conform unei scale de gradare de la benign la malign, cu impact \u00een decizia terapeutic\u0103 (monitorizare, radioterapie, interven\u021bie chirurgical\u0103).
\nIRM este metoda imagistic\u0103 cu cea mai mare sensibilitate \u00een evaluarea extensiei locale a tumorii (informa\u021bie necesara pentru planning-ul terapeutic).
\nIRM permite localizarea leziunilor suspecte \u0219i ghidarea biopsiei \u00een arii mai dificil de abordat pe cale intrarectal\u0103 (cancere inferioare, cancere ventrale).<\/p>\n

Avantaje IRM de prostat\u0103 fa\u021b\u0103 de CT:<\/strong><\/span>
\n\u2022 caracterizeaz\u0103 mult mai bine leziunile focale intraparenchimatoase;
\n\u2022 este neiradiant\u0103 \u2013 investiga\u021bia de elec\u021bie la persoanele tinere, la cele care au nevoie de examin\u0103ri imagistice seriate \u0219i la gravide;
\n\u2022 capacitate de achizi\u021bie multiplanar\u0103. Protocolul de achizi\u021bie IRM se poate completa cu angiografia RM arterial\u0103 \u0219i venos\u0103 abdominal\u0103, cu sau f\u0103r\u0103 substan\u021b\u0103 de contrast, pentru identificarea unor leziuni stenozante, tromboze, ocluzii, malforma\u021bii vasculare sau a unor semne de invazie vascular\u0103 tumoral\u0103.<\/p>\n

VI. IRM \u00een patologia ginecologic\u0103<\/strong>
\n\u2022 IRM aduce informa\u021bii de fine\u021be, cu posibilitate de reconstruc\u021bii bi- \u0219i tridimensionale, asupra leziunilor complexe pelviene;
\n\u2022 IRM prezint\u0103 o sensibilitate de 93% \u0219i o specificitate de 97% \u00een detec\u021bia tumorilor maligne;
\n\u2022 permite identificarea originii \u00een cazul tumorilor pelvine, inclusiv a celor insuficient caracterizate ecografic;
\n\u2022 permite, prin detec\u021bia componentelor gr\u0103soase, sangvine sau fibroase intratumorale, un diagnostic de \u00eencredere \u00een cazul chistelor dermoide, endometrioamelor sau fibroamelor uterine (cele mai frecvente patologii care mimeaz\u0103 ecografic patologia malign\u0103);
\n\u2022 \u00een cazul leziunilor chistice solide anexiale la pacientele tinere cu markeri tumorali u\u0219or crescu\u021bi cu aspect ,,borderline\u201d (cu suprapuneri ale caracterelor de benignitate-malignitate), IRM pelvin aduce informatii suplimentare, utile chirurgului \u00een planificarea unei interven\u021bii conservatoare sau radicale \u0219i \u00een selec\u021bia preoperatorie a pacientelor potrivite pentru laparoscopie vs laparotomie;
\n\u2022 IRM este util\u0103 \u00een identificarea cazurilor \u00een care se pot evita proceduri chirurgicale extensive.<\/p>\n

Aplica\u021bii:<\/strong><\/span>
\n– Stadializarea neoplasmelor ginecologice: IRM reprezint\u0103 investiga\u021bia imagistic\u0103 de prim\u0103 linie \u00een stadializarea cancerului cervical (invazie parametrial\u0103) \u0219i endometrial (invazie miometrial\u0103 \u0219i cervical\u0103) \u0219i \u00een caracterizarea maselor anexiale.
\n– Ghidarea tratamentului: chirurgical versus radioterapie \u00een cancerul cervical; histerectomie radical\u0103 \u0219i limfadenectomie versus histerectomie simpl\u0103 \u00een cancerul endometrial.
\n– Detec\u021bia recuren\u021belor: contrastul tisular superior permite detec\u021bia precoce a bolii pelvine localizate.<\/p>\n

VII. IRM testicular<\/strong>
\n\u2022 permite caracterizarea suplimentar\u0103 a leziunilor testiculare \u0219i scrotale decelate \u00een examinarea ecografic\u0103;
\n\u2022 permite evaluarea tumorilor testiculare \u0219i a gradului de diseminare local\u0103 sau la distan\u021b\u0103 \u00een momentul diagnosticului, cu impact \u00een alegerea tratamentului oncologic adecvat pentru pacient;
\n\u2022 util\u0103 \u00een monitorizarea posttratament a tumorilor testiculare;
\n\u2022 permite detectarea precoce a recidivelor tumorale.<\/p>\n

B. IRM mamar:<\/strong><\/span>
\nEste util \u00een diagnosticul leziunilor benigne (chisturi, abccese, fibroz\u0103, fibroadenoame, ectazii ductale, hiperplazie ductal\u0103) \u0219i \u00een diagnosticul leziunilor maligne: localizarea, distribu\u021bia, stadializarea \u0219i depistarea determin\u0103rilor secundare.<\/p>\n

Indica\u021bii:<\/strong> <\/span>
\n\u2022 detec\u021bia cancerului primitiv al s\u00e2nului cu nodul echivoc \u00een examinarea ecografic\u0103 sau mamografic\u0103 conven\u021bional\u0103;
\n\u2022 detec\u021bia leziunilor multifocale, \u00een special a cancerului lobular;
\n\u2022 detec\u021bia carcinomului contra-lateral;
\n\u2022 detec\u021bia metastazelor \u00een limfoganglionii axilari la un cancer primar ne\u0219tiut\/nediagnosticat;
\n\u2022 evaluarea invaziei peretelui toracic;
\n\u2022 retrac\u021bia suspect\u0103 a mamelonului, f\u0103r\u0103 modific\u0103ri decelabile \u00een examinarea mamografic\u0103 conventional\u0103 (Rx) sau ecografic\u0103;
\n\u2022 evaluarea implanturilor de s\u00e2n;
\n\u2022 screening la pacientele cu risc \u00eenalt de cancer (de exemplu: paciente cu predispozi\u021bie familial\u0103);
\n\u2022 evaluarea statusului preterapeutic\/preoperator (stadializare), \u00een special \u00een cazul s\u00e2nilor den\u0219i \u00een examinarea mamografic\u0103 conven\u021bional\u0103;
\n\u2022 biopsia MR ghidat\u0103 a leziunilor invizibile la mamografia conven\u021bional\u0103 sau ecografie;
\n\u2022 evaluarea \u0219i monitorizarea r\u0103spunsului la tratamentul adjuvant chimioterapic.<\/p>\n

\u00cen compara\u021bie cu mamografia conven\u021bional\u0103 (Rx) sau cu ecografia:<\/strong><\/span>
\n\u2022 este o tehnic\u0103 neiradiant\u0103;
\n\u2022 ofer\u0103 imagini de ansamblu ale s\u00e2nilor;
\n\u2022 este independent\u0103 fa\u021b\u0103 de operator, comparativ cu examenul ecografic;
\n\u2022 ofer\u0103 o rezolu\u021bie spa\u021bial\u0103 \u00eenalt\u0103 0,8×0,8×2-3mm);
\n\u2022 detecteaz\u0103 leziunile nedecelabile mamografic sau ecografic;
\n\u2022 detecteaz\u0103 \u0219i localizeaz\u0103 precis leziunile \u0219i apreciaz\u0103 extensia \u0219i m\u0103rimea acestora;
\n\u2022 face diagnosticul diferen\u021bial benign\u2013malign.<\/p>\n

C. IRM \u00een patologia oncologic\u0103 cerebral\u0103:<\/strong><\/span><\/p>\n

Secvente dedicate:<\/p>\n

DTI (Diffusion Tensor Imaging)<\/strong>
\nEste o tehnic\u0103 neuroimagistic\u0103 de m\u0103surare a difuziei anizotrope, care permite vizualizare in vivo a tracturilor de\u00a0substan\u021b\u0103 alb\u0103. Aduce informa\u021bii importante privind organizarea geometric\u0103 \u0219i microstructural\u0103 a substan\u021bei albe.
\nEste eficient\u0103 \u00een depistarea bolilor care provoac\u0103 deteriorare sau deplasare axonal\u0103.<\/p>\n

\u00cen eveluarea imagistic\u0103 a tumorilor cerebrale DTI permite delimitarea tumorilor \u0219i evaluarea \u021besutului peritumoral\u00a0(infiltra\u021bia, devierea \u0219i distruc\u021bia tracturilor) \u0219i este util\u0103 \u00een distingerea gliomului de metastazele solitare, \u00een stabilirea protocolului preoperator, a tratamentului radioterapeutic \u0219i \u00een evaluarea r\u0103spunsului la terapie.<\/p>\n

PWI\u2013 Perfusion Weighted Imaging<\/strong>
\nPerfuzia IRM \u0219i CT (PWI) aduce indicii asupra func\u021biei cerebrale prin m\u0103surarea unor parametri hemodinamici precum:\u00a0volumul sangvin cerebral, fluxul sangvin cerebral \u0219i timpul mediu de tranzit.
\n\u00cen evaluarea imagistic\u0103 a tuorilor cerebrale, PWI face diagnosticul diferen\u021bial rest\/recidiv\u0103 tumoral\u0103 versus necroz\u0103 postiradiere, c\u00e2nd secven\u021bele conven\u021bionale IRM sunt echivoce; evalueaz\u0103 neovasculariza\u021bia intratumoral\u0103, care se coreleaz\u0103 cu gradul tumoral (diferen\u021biere glioame \u201clow grade\u201d de glioame \u201chigh grade\u201d); evalueaz\u0103 noninvaziv tumorile: prin combinarea mai multor parametri de difuzie \u0219i perfuzie (ADCmin, rCBV max) se pot diferen\u021bia tumori maligne intracerebrale gadolinofile;
\nPWI este util\u0103 \u00een planningul preterapeutic, pentru optimizarea managementului pacientului(chimioterapie, radioterapie, chirurgie); evalueaz\u0103 precoce eficien\u021ba agen\u021bilor terapeutici, \u00een special a celor care suprim\u0103\u00a0cre\u0219terea vaselor de s\u00e2nge intratumorale.<\/p>\n

Spectroscopia prin rezonan\u021b\u0103 magnetic\u0103 (MRS)<\/strong>
\nOfer\u0103, non-invaziv, informa\u021bii despre metabolismul \u0219i structura biochimic\u0103 a unor organe \u0219i \u021besuturi. MRS pune \u00een\u00a0eviden\u021b\u0103 metaboli\u021bi al c\u0103ror dezechilibru poate indica diverse afec\u021biuni.<\/p>\n

Aplica\u021bii ale spectroscopiei \u00een patologia oncologic\u0103 cerebral\u0103:
\n\u2022 caracterizeaz\u0103 \u0219i diferen\u021biaz\u0103 leziunile focale intraparenchimatoase cerebrale: tumori (stadializarea gradului de malignitate), metastaze, abcese, leziuni demielinizante, limfom, encefalite;
\n\u2022 este util\u0103 \u00een monitorizarea postterapeutic\u0103 a tumorilor cerebrale (diferen\u021biaz\u0103 restul\/recidiva tumoral\u0103 de\u00a0modific\u0103rile posttratament);<\/p>\n

SWI \u2013 Susceptibility Weighted Imaging<\/strong>
\nSWI este o tehnic\u0103 recent\u0103 \u00een neuroimagistic\u0103 medical\u0103, care folose\u0219te diferen\u021bele de susceptibilitate magnetic\u0103 dintre \u021besuturi \u0219i ofer\u0103 un contrast net superior fa\u021b\u0103 de imaginile PD, T1, T2 \u0219i T2* 2D GRE. SWI este cea mai bun\u0103 metod\u0103 de vizualizare a sistemului venos cerebral; SWI detecteaz\u0103 depozitele de fier din \u021besuturi,
\nmicrocalcific\u0103rile \u0219i microhemoragiile intraparenchimatoase.<\/p>\n

\u00cen patologia tumorala, SWI este util\u0103 \u00een detectarea hemoragiilor intratumorale, \u00een delimitarea \u0219i caracterizarea tumorilor \u0219i \u00een eviden\u021bierea venelor de drenaj.<\/p>\n

DWI \u2013 Diffusion Weighted Imaging<\/strong>
\nDWI investigheaz\u0103 difuzia apei la nivel celular, oferind informa\u021bii func\u021bionale esen\u021biale despre \u021besuturi. DWI caracterizeaz\u0103 leziunile infracentimetrice \u0219i modific\u0103rile intraparenchimatoase, \u00eenainte ca acestea s\u0103 fie vizibile \u00een secven\u021bele conven\u021bionale (morfologice). Recent, difuzia s-a dezvoltat dincolo de patologia cerebral\u0103 \u0219i are azi diverse aplica\u021bii extracraniene.
\nAplica\u021bii clinice ale DWI \u00een patologia oncologic\u0103:
\n\u2022 detectarea \u0219i caracterizarea forma\u021biunilor tumorale primare \u0219i secundare;
\n\u2022 diagnosticul diferen\u021bial benign vs malign.
\n\u2022 caracterizarea tumorilor \u0219i ghidarea biopsiei;
\n\u2022 urm\u0103rirea evolu\u021biei tumorilor postradioterapie\/chimioterapie;
\n\u2022 \u00een patologia medular\u0103: diagnostic diferen\u021bial tumori versus infarct medular, leziuni demielinizante, contuzii medulare etc.<\/p>\n

\u201eWhole Body Diffusion MRI\u201d:<\/strong>
\n\u2022 Screening al \u00eentregului corp pentru depistarea focarelor tumorale la distan\u021b\u0103 (ganglionare, hepatice, osoase etc.); studii recente au demonstrat o sensibilitate \u0219i specificitate similare cu ale imaginilor PET;
\n\u2022 caracterizarea \u00een detaliu a tumorilor primare\/secundare;
\n\u2022 monitorizarea evolu\u021biei \u00een cursul radio\u0219i chimioterapiei.<\/p>\n

\n

Echipa medicala MEDINST Diagnostic
\nRom\u00e2no-German<\/p>\n

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

\n","protected":false},"excerpt":{"rendered":"

A. IRM \u00een patologia abdomino-pelvin\u0103 I. IRM hepato-bilio-pancreatic Aplica\u021biile IRM \u00een patologia hepatic\u0103: \u2022 depisteaz\u0103 \u0219i caracterizeaz\u0103 leziunile focale solide intrahepatice: leziuni primare (hiperplazia focal\u0103 nodular\u0103, adenom, hepatocarcinom, colangiocarcinom intrahepatic […]<\/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":[33,168],"tags":[442],"class_list":["post-5121","post","type-post","status-publish","format-standard","has-post-thumbnail","category-articole","category-oncologie","tag-medinst"],"yoast_head":"\nIRM \u015fi CT \u00een patologia oncologic\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-si-ct-in-patologia-oncologica\/\" \/>\n<meta property=\"og:locale\" content=\"ro_RO\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"IRM \u015fi CT \u00een patologia oncologic\u0103 - Jurmed - Medici\" \/>\n<meta property=\"og:description\" content=\"A. IRM \u00een patologia abdomino-pelvin\u0103 I. 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