KUSETEEDE, KUSEPÕIE JA EESNÄÄRME MRT. Vladimir Järv
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1 KUSETEEDE, KUSEPÕIE JA EESNÄÄRME MRT Vladimir Järv
2 KUSETEED MRT EELISTATUD RASE, LOODE, LAPS I - ALLERGIA, NEERUPUUDULIKKUS
3 KUSETEEDE MRT SAGEDASEMAD NÄIDUSTUSED KUSETEE AHENEMINE ARENGUANOMAALIA KIVI jm HEALOOMULINE PÕHJUS MALIIGSED PROTSESSID FUNKTSIOONI HÄIRE: URIINI RETENSIOON, PIDAMATUS
4 MRU JA T2 SAG RASEDUS - FÜSIOLOOGILINE HÜDRONEFROOS
5 MRU JA T2 COR RASEDUS, VASEMAL KORALLKIVI
6 LOOTE MRT ARENGUANOMAALIA PAREMAL TOPELT KOLLEKTORSÜSTEEM EKTOOPILINE URETEROTSEELE
7 SAMA PATSIENT 12 PÄEVANE IMIK MRU ARENGUANOMAALIA BILATERAALNE KOLLEKTORSÜSTEEMI DUPLIKATSIOON EKTOOPILINE URETEROTSEELE
8 ARENGUANOMAALIA UREETERO-PELVIKAALSE ÜLEMINEKU (UPJ) STENOOS
9 MRT PUUDUS MADAL RESOLUTSIOON VÄIKSED KIVID JA UROTELIAALSED TU JÄÄVAD DIAGNOOSIMATA KT - KARIKA JA VAAGNA KIVI MRT - NÄHA VAID VAAGNA KIVI
10 TUUMOR TRANSITOORRAKULINE CA-TCC
11 VÄLISSURVE MRU - UREETRI SULGUS T2 COR PROSTATA CA JA LN MTS
12 NEERUFUNKTSIOONI UURIMINE MRU JA EKSKRETOORNE MR KROONILINE OBSTRUKTSIOON
13 NORMAALNE NAISE UREETRA AKS T2 JA T1 FS GAD - KONTSENTRILISED RINGJAD STRUKTUURID SAG T2 - TUBULAARNE STRUKTUUR
14 UREETRA MRT UREETRA DIVERTIIKUL SAMA + TU LISAKS VÕIB OLLA KIVI, INFEKTSIOON, TU!
15 UREETRA MRT T2 SAG FSE MEHE UREETRA LAMERAKULINE CA!
16 KUSEPÕIE MRT VAAGNAS ON VÄHE LIIKUMISARTEFAKTE, SAAB KASUTADA PIKEMAAJALISI SEKVENTSE - PAREM RESOLUTSIOON HEA PEHME KOE JA URIINI KONTRAST PEAMINE NÄIDUSTUSED - PÕIE TU AVASTAMINE JA LEVIKUULATUSE MÄÄRAMINE
17 SUUR TUUMOR TU LAIALDANE LOKAALNE LEVIK SEEMNEPÕIEKESTELE,PROSTATALE,,VAAGNASEINALE PÕIE TU LN MTS
18 SUUR TUUMOR T1 SAG GAD PÕIE TU JA PROSTATA ADENOOM
19 VÄIKE TUUMOR
20 Urinary Bladder Cancer: Diffusion-weighted MR Imaging Accuracy for Diagnosing T Stage and Estimating Histologic Grade 1 Mitsuru et al, April 2009 Radiology, 251, T2 JA DÜNAAMILINE KONTRASTURING (DCE) AKSIAAL - TCC ON LEVINUD LIHASKIHILE
21 Urinary Bladder Cancer: Diffusion-weighted MR Imaging Accuracy for Diagnosing T Stage and Estimating Histologic Grade 1 Mitsuru et al, April 2009 Radiology, 251, DIFUSIOONKAALUTUD KUJUTIS (DWI) TU EI OLE LEVINUD LIHASKIHILE
22 LEIOMÜOOM, VEREHÜÜVE
23 PROSTATA CA! (PCA) AVASTAMINE STAADIUMI MÄÄRAMINE, RAVI JUHTIMINE RAVIJÄRGNE JÄLGIMINE
24 PCA AVASTAMINE PSA laialdane kasutus - VARASEM AVASTAMINE
25 PCA PILTDIAGNOSTIKA ENDO UH BIOPSIA, BRAHHÜTERAAPIA ENDO MRT/ MRT LOKAALNE LEVIK KT KAUGELEARENENUD HAIGUS PET/KT RAVIJÄRGNE JÄLGIMINE SKELETI ISOTOOP UURING LUUMTS.
26 Miks on staadiumi määramine oluline? PCA STAADIUMI TÄPNE MÄÄRAMINE ON VÄGA OLULINE STAADIUMI PÕHJAL VALITAKSE SOBIV RAVIMEETOD RAVI SOBIVUSEST SÕLTUB PROGNOOS
27 TX Primary tumor cannot be assessed T0 No evidence of primary tumor T1 Clinically inapparent tumor not palpable or visible by imaging T1a Tumor incidental histologic finding in 5% or less of tissue resected T1b Tumor incidental histologic finding in more than 5% of tissue resected T1c Tumor identified by needle biopsy (e.g. because of elevated PSA) T2 Palpable tumor confined within prostate * T2a Tumor involves half of a lobe or less T2b Tumor involves more than half of a lobe, but not both lobes T2c Tumor involves both lobes T3 Tumor extends through the prostatic capsule T3a Unilateral extracapsular extension T3b Bilateral extracapsular extension T3c Tumor invades seminal vesicle(s) T4 Tumor is fixed or invades adjacent structures other than seminal vesicles T4a Tumor invades external sphincter and/or bladder neck and/or rectum T4b Tumor invades levator muscles and/or is fixed to pelvic wall
28 EESNÄÄRME SISEEHITUS Basaalosa Keskosa Apikaalosa
29 MRT PCA UURIMISEL TÄHTSUS TÕUSEB, KOHATI VÄGA POPULAARNE VAHEL ABI PCA AVASTAMISEL ( PSA tõus, BI - ) 3T MRT REKTAALMÄHISE KASUTAMISE VAJADUS?
30 AKSIAALTASANDIS T 2 PROSTATA SISESTRUKTUUR ON ERISTATAV KIRURGILINE PSEUDOKAPSEL
31 ENDOREKTAAL MRT NORMANATOOMIA aksiaalne T2 basise tasand
32 Kuidas PCA MRT-l välja näeb? HISTOLOOGILISED VÄHIKAARDID
33 PATIENT I AKSIAALNE T2 PCA HÜPOINTENSIIVNE
34 PATIENT I
35 PATIENT I
36 PATIENT I
37 PATIENT I
38 PATIENT I
39 PATIENT I
40 KLASSIKALINE PROSTATA VÄHK MRT T2 - hüpointensiivne (tume ala) NORMAALNE PERIFEERNE TSOON - hüperintensiivne (hele) prostatiit düstroofilised muutused hemorraagia võivad vähki imiteerida Mutsinoosne vähk võib sarnaneda normaalsele koele iso või kergelt hüperintensiivne
41 ENDO MRT T2 AKS, SAG, KOR. TII B, PSA 5,1 PAREMAL KESK- JA APIKAALOSAS DORSO- LATERAALSEL HÜPOINTENSIIVNE ALA, MIS PIIRDUB KAPSLIGA
42 EKSTRAKAPSULAARNE LEVIKU (EKL) SEEMNEPÕIEKESTE INVASIOON (VSI) EKL TUNNUSED VÄHENE EKL KAPSLI RETRAKTSIOON, TU - KAPSLI KONTAKT ÜLE 1 CM, KAPSLI KATKEMINE PR-ST VÄLJUV TUUMORIMASS NEUROVASKULAARSE KIMBU ASÜMMEETRIA TU MASS NEUROVASKULAARKIMBUS REKTO-PROSTATIILISE NURGA TÄITUMINE VSI TUNNUSED KATKEB VÕI KAOB NORMAALNE SISESTRUKTUUR, MADALINT. ALA VS-S P JA VS VAHELISE NURGA TÄITUMINE, OTSENE TU JÄTKUMINE BASISELT VS-LE
43 ENDO MRT PCA paremal basaalsel EKL; VSI bilat.
44 VENTRAALOSA TU OTSIDA PSA KÕRGE JA BI NEG- SEALT BI SAGELI EI VÕETA ERILINE TÄHELEPANU, KUI MRT-L PERIFEERSE TSOONI LEID PUUDUB CA TUNNUSED HOMOGEENNE MADALINTENSIIVNE PIIRKOND, HÄGUSALT PIIRDUNUD VÕI KIIRJA PIIRIGA MUUTUS MADALINTENSIIVSE KONTUURI PUUDUMINE (TAVALISELT ESINEB ADENOOMIDEL) KIRURGILISE PSEUDOKAPSLI KATKEMINE UREETRA VÕI EESMISE FIBRO-MUSKULAARSE STROOMA INVASIOON PCA FIBROMUSKULAARSES OSAS - EKL KLIINIILISELT PROSTATA N
45 T STAADIUMI MÄÄRAMINE MRT TÄPSUS T STAADIUMI MÄÄRAMISEL ON 54 93%, HINDAJATE VAHEL SUURED ERINEVUSED EKL AVASTAMISEL ON TUNDL 13-95%, SPETS 49 97% VSI AVASTAMISEKS 23-80% TUNDL JA 81-99% SPETS PAREMAD TULEMUSED, KUI MRT HINDAB MITTE ÜLDRADIOLOOG VAID ERITREENINGUGA MRT UROGENITAALRADIOLOOG - KOGEMUS
46 M JA N STAADIUMI MÄÄRAMINE Aks T1 SKELETI MTS Kor T2 PCA EKL MTS LÜMFISÕLMED
47 DWI JA DCE PCA EKSTRATSELLULAARRUUM ON SUUR (INTERSTITSIAALVEDELIK ROHKE) - NORMAALSEST P KOEST OLULISELT KÕRGEM DIFUSIOONKOEFITSENT SARNASELT TEISTE MAL TU-GA ON PCA -L TEGEMIST ANGIOGENEESIGA PCA-L ON SAGELI KIIRE KONTRASTEERUMINE JA KIIRE WASH-OUT a T2 aks, b DWI ADC map, c DWI b 1400, d DCE kõver, e DCE värviga märgistatud f T2 sag
48 HISTOL JA MRT / 3 D MRS MRS Hematoksüliin-eosiin Pat. Hist. preparaat kinnitab MRT leidu - EKL PCA T2 aks MRT ja vastavate vokselite spektroskoopia Madalintensiivne ala paremal perifeerses näärmes laialdane (<1 cm) kontakt kapsliga, väljavõlvuvus kontuuril, rektoprost. nurk on täidetud - EKL tunnused Spektraalanalüüs koliini tõus, tsitraat madal kinnitab PCA leidu * vokselites
49 MRT/MRS JA DCE MRT LEID EBASPESTIIFILINE (KOGU PROSTATA ON HÜPOINTENSIIVNE) DCE JA MRS VASEMAL ON PCA
50 MRT PCA KIIRITUSRAVI PLANEERIMISEL PCA st I c, UREETRA HAARATUS- OLULINE KIIRITUSRAVI PLANEERIMISEL
51 MRT PCA RAVIJÄRGSEL JÄLGIMISEL PSA TÕUS LOKAALRETSIDIIV KAUGMETASTAASID
52 PCA LUUSTIKU MTS-D LUUSTIKU ISOTOOPUURING TAVARÖNTGENIST TUNDLIKUM PSA > 100 T99m isotoopuuring hulgimetastaasid luustikus
53 MRT ON ISOTOOPUURINGUST TUNDLIKUM JA SPETSIIFILISEM MRT VALE POSITIIVNE - INFEKTSIOON, INFARKT, TRAUMA MRT ON LIMITEERITUD VÄIKSEMALE PIIRKONNALE KUI ISOTOOPUURING MRT HÄBEMELUU MTS, TULI NÄHTAVALE TEISEL ISOTOOPUUIRNGUL ( ESIMENE OLI NEG), 3 KUUD MRT-ST HILJEM
54 PCA RAVIJÄRGNE JÄLGIMINE MRT LOKAALRETSIDIIV
55 KOKKUVÕTE MRT sobib hästi prostata, kusepõie ( vaagna ) ja kuseteede uurimiseks TULEVIK MRT UURINGUTE KASV kättesaadavuse paranemine klinitsistide teadlikkuse tõus, nõudluse suurenemine radioloogide subspetsialiseerumine, koostöö uroloogidega
56 KASUTATUD MATERJALID Imaging Prostate Cancer: A Multidisciplinary Perspective H. Hricak, et al. RSNA, 2007 Advancements in MR Imaging of the Prostate: From Diagnosis to Interventions David Bonekamp, et al. May 2011 RadioGraphics, 31, Abdominal and Pelvic MRI. A.Heuck, M. Reiser Springer
57 KASUTATUD MATERJALID Imaging Prostate Cancer: A Multidisciplinary Perspective H. Hricak, et al. RSNA, 2007 Advancements in MR Imaging of the Prostate: From Diagnosis to Interventions David Bonekamp, et al. May 2011 RadioGraphics, 31, Abdominal and Pelvic MRI. A.Heuck, M. Reiser Springer
I have no financial relationships to disclose. I WILL NOT include discussion of investigational or off-label use of a product in my presentation.
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