Aplicação de um protocolo de espectroscopia por ressonância magnética das adrenais: experiência com mais de 100 casos

• Autor(a) principal: Melo, Homero José de Farias e [UNIFESP]
• Data de Publicação: 2014
• Outros Autores: Goldman, Suzan M., Szejnfeld, Jacob [UNIFESP], Faria, Juliano F., Huayllas, Martha K. P., Andreoni, Cássio [UNIFESP], Kater, Claudio Elias [UNIFESP]
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Repositório Institucional da UNIFESP
• dARK ID: ark:/48912/0013000019fr6
• DOI: 10.1590/0100-3984.2013.1812
• Texto Completo: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-39842014000600009&lng=en&nrm=iso; http://repositorio.unifesp.br/handle/11600/8717
• topic: Glândula adrenal; Ressonância magnética; Espectroscopia; Adrenal gland; Magnetic resonance imaging; Spectroscopy

Objective: To evaluate a protocol for two-dimensional (2D) hydrogen proton (1H) magnetic resonance spectroscopy (MRS) (Siemens Medical Systems; Erlangen, Germany) in the detection of adrenal nodules and differentiation between benign and malignant masses (adenomas, pheochromocytomas, carcinomas and metastases). Materials and Methods: A total of 118 patients (36 men; 82 women) (mean age: 57.3 ± 13.3 years) presenting with 138 adrenal nodules/masses were prospectively assessed. A multivoxel system was utilized with a 2D point-resolved spectroscopy/chemical shift imaging sequence. The following ratios were calculated: choline (Cho)/creatine (Cr), 4.0–4.3/Cr, lipid (Lip)/Cr, Cho/Lip and lactate (Lac)/Cr. Results: 2D-1H-MRS was successful in 123 (89.13%) lesions. Sensitivity and specificity values observed for the ratios and cutoff points were the following: Cho/Cr ≥ 1.2, 100% sensitivity, 98.2% specificity (differences between adenomas/pheochromocytomas and carcinomas/ metastases); 4.0–4.3 ppm/Cr ≥ 1.5, 92.3% sensitivity, 96.9% specificity (differences between carcinomas/pheochromocytomas and adenomas/metastases); Lac/Cr ≤ –7.449, 90.9% sensitivity and 77.8% specificity (differences between pheochromocytomas and carcinomas/adenomas). Conclusion: Information provided by 2D-1H-MRS were effective and allowed for the differentiation between adrenal masses and nodules in most cases of lesions with > 1.0 cm in diameter.