Catalano, Marco (2017) MR imaging of tenosynovial giant cell tumor: additional value of a T2*-weighted gradient echo sequence. [Tesi di dottorato]

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Item Type: Tesi di dottorato
Lingua: English
Title: MR imaging of tenosynovial giant cell tumor: additional value of a T2*-weighted gradient echo sequence
Creators:
CreatorsEmail
Catalano, Marcomarco26catalano@yahoo.it
Date: 10 December 2017
Number of Pages: 41
Institution: Università degli Studi di Napoli Federico II
Department: dep18
Dottorato: phd076
Ciclo di dottorato: 30
Coordinatore del Corso di dottorato:
nomeemail
Cuocolo, Albertocuocolo@unina.it
Tutor:
nomeemail
Cuocolo, AlbertoUNSPECIFIED
Date: 10 December 2017
Number of Pages: 41
Uncontrolled Keywords: Tenosynovial giant cell tumor; Pigmented villonodular synovitis; Gradient echo; Magnetic Resonance.
Settori scientifico-disciplinari del MIUR: Area 06 - Scienze mediche > MED/36 - Diagnostica per immagini e radioterapia
Date Deposited: 18 Dec 2017 12:27
Last Modified: 02 Apr 2019 10:43
URI: http://www.fedoa.unina.it/id/eprint/12127

Abstract

Title: MR imaging of tenosynovial giant cell tumor: additional value of a T2*-weighted gradient echo sequence Background/Purpose: To evaluate the role of a T2*-weighted gradient echo (GRE) sequence added to a standard MR imaging protocol in assessing the iron content of tumor tissue and the extent of joint involvement in patients with tenosynovial giant cell tumor (TGCT). Methods and Materials: MR studies of 58 patients (mean age: 36,7 years; 35 female, 23 male) with histologically proven TGCT (knee: n=44, hip: n=5, ankle: n=5, elbow: n=1, tarsus: n=1, tendon sheath: n=2) obtained prior to surgical resection were retrospectively analyzed. All examinations were performed according to a standardized protocol which in addition to T1-, T2-weighted and CE SE/TSE sequence a T2*-weighted GRE sequence is included. Standard and GRE images were separately analyzed by three independent observers with regard to 1) relative iron content of tumor tissue as determined by the distribution and extent of blooming (susceptibility) artifacts (0-absent, 1-focal (<30%), 2-moderate/confluent (30-70%), 3-massive/diffuse (>70%)) and 2) the identification of tumor tissue on GRE images in joint compartments which appeared uninvolved on images of standard sequences. Intraoperative and histologic findings served as the standards of reference. All histologic specimens were reviewed and iron content was graded corresponding to the above mentioned classification by an experienced pathologist. Results: 59% of the lesions were classified (WHO 2013) as localized and 41% as diffuse TGCTs. On histologic review, the iron content was graded as follows: 0: n=2, 1: n=13, 2: n=29, 3: n=14. The diagnostic accuracy of GRE images in assessing the iron content of tumor tissue accordingly was 88%, 79% and 81% with K values of 0.812, 0.683 and 0.715 for observer 1, 2, and 3 respectively. Interobserver agreement was excellent with kappa values ranging from 0.843 to 0.905. Overall, iron deposits were depicted on histopathology in 96.5% and on MR images in 93-96,5% of TGCTs. On GRE images the observers diagnosed involvement of joint compartments not seen on standard images alone in 6/58 (10%), 6/58 (10%), and 5/58 (8%) of cases. Conclusions: A T2*-weighted GRE sequence added to a standard MR protocol allows accurate and reproducible quantification of iron content in TGCTs. Due to the high incidence of iron deposits in these synovial lesions, this ability together with typical MR findings on T1 and T2 weighted images might be of help to establish the diagnosis more confidently. Furthermore, GRE images depict tumor manifestations in joint compartments that can appear uninvolved on standard images and thus, are helpful in planning of surgical treatment.

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