RU2446747C1 - Method of diagnosing micrometatases of malignant tumors - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to magnetic-resonance tomography and can be used for determination of magnetic-resonance characteristics of different histological types of malignant tumours and detection in normal tissues of segments of their metastatic disease. Segment of pathological tissue (primary tumour, metastatic lymph node, distant metastasis) is detected. Measured are parameters TE time of echo and TR time of recovery in inversion-recovery with short T1- sequence before obtaining series of clear magnetic-resonance images, in which at the background of suppressed signal from normal surrounding tissues determined is hyperintensive tumour tissue. Search sequences with minimal amount of cuts are programmed. Achieved level of magnetic-resonance signal corresponds to histological type of tumour. Parameters TE time of echo and TR time of recovery in examination by sequence inversion-recovery of other body parts are reproduced, and search of analogous in proton density tissues in any organ and part of skeleton, in each group of lymph nodes and brain tissue is carried out.

EFFECT: method makes it possible to obtain clear image of micrometatases of malignant tumours, cancer lymphangitis, metastatic affection of lymth nodes.

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Description

The invention relates to medicine, namely to magnetic resonance imaging, and can be used to determine the magnetic resonance characteristics of various histotypes of malignant tumors and detect areas of normal metastasis in normal tissues.

A known method of 3D diffusion-weighted magnetic resonance imaging of the whole body, which provides visualization of metastatic foci of more than 0.5 cm, but does not have high spatial resolution, images are similar in quality to positron emission tomograms and do not provide a clear visualization of the anatomy of an organ changed by the pathological process (see M.B.Dolgushin, L.M. Fadeeva, A.Yu. Zaitseva, I.N. Pronin, V.N.Kornienko. 3D-diffusion-weighted magnetic resonance imaging of the whole body in patients with metastatic p brain reflection // Medical visualization. 2008. No. 1. S.118-123).

The known "method for the study of the whole body using STIR and T2 sequences", selected as a prototype. An image of the whole body is obtained from the operator’s console in three stages by moving successively three anatomical regions into the isocenter of the magnetic field: 1) head and neck, 2) chest and abdominal cavity, 3) pelvis and proximal hips. In the study of the second anatomical region, trigger synchronization with respiration was used. An image of each anatomical region was obtained in the coronary plane with a slice thickness of 8 mm, an interslice gap of 1 mm, using a 512 × 384 matrix and two pulse sequences: SE with parameters TR / TE = 650/20 ms to obtain T1VI; and STIR with parameters TR / TI / TE = 5670/150 / 10-75 ms to obtain T2VI with signal suppression from fat. The total duration of the study was about 30 minutes. The disadvantage of this method is the lack of axial and sagittal sections necessary for assessing the volumetric effect of metastatic lesions and its low resolution due to the large thickness of the section and, therefore, the large volume of voxel (Diagnosis of bone metastases: possibilities of the method of magnetic resonance imaging of the whole body of D.V. .Neledov, NZ Shavladze Medical Radiological Research Center of the Russian Academy of Medical Sciences, Obninsk, Siberian Oncology Journal. 2009. Appendix No. 1).

The aim of the invention is to obtain a clear image of the micrometastases of malignant tumors, cancer lymphangitis metastatic lesions of the lymph nodes.

This goal is achieved by the fact that after the identification of the pathological tissue site: the primary tumor, metastatic lymph node, distant metastasis, the TE parameters are changed - echo time and TR - recovery time in the inversion-recovery sequence with a short T1, until a series of clear magnetic resonance images are obtained, in which, against the background of a suppressed signal from normal surrounding tissues, hyperintensive tumor tissue is determined, search sequences with the minimum number of slices achieved in the deer of the magnetic resonance signal corresponds to the histological type of the tumor, subsequently reproducing the TE parameters echo time and TR recovery time when studying the inversion-restoration sequence of other parts of the body and search for tissues similar in proton density in any organ and skeleton section, in each group of lymph nodes and in brain tissue. The invention "A method for the diagnosis of micrometastases of malignant tumors" is new as it is unknown in the field of magnetic resonance imaging in oncology in the study of the spread of the tumor and the boundaries of its metastasis.

The novelty of the invention is to obtain a special sequence repeated with the capture of the primary focus area, and then on the area of possible metastasis. The TE (echo time) and TR (recovery time) parameters are selected during the study by the inversion-recovery sequence to obtain clear, bright, contrasting magnetic resonance images, in which, against the background of the suppressed signal from normal surrounding tissues, hyperintensive tumor tissue is identified that is magnetically identical -resonant signal in the primary focus and in all metastatic lesions. The sequence allows to qualitatively solve the problem of searching for metastatic foci in the bones, soft tissues, lymph nodes when determining the prevalence of the oncological process, to determine the boundaries of pathological tissue, cancer lymphangitis. The invention is industrially applicable, as it can be reproduced and repeated many times in medical institutions, research institutes, oncology clinics.

"Method for the diagnosis of micrometastases of malignant tumors" is as follows. According to the clinical, x-ray or ultrasonographic examination of the patient, as well as the localization sequence, a section of pathological tissue (primary tumor, metastatic lymph node, distant metastasis) is selected, the TE (echo time) and TR (recovery time) parameters are changed to inversion-recovery with a short T1- sequences until a series of clear magnetic resonance images are obtained, in which, against the background of a suppressed signal from normal surrounding tissues, a hyperintensive tumor is determined searching tissue with the minimum number of sections, the achieved level of the magnetic resonance signal corresponds to the histological type of the tumor, subsequently reproducing the TE (echo time) and TR (recovery time) parameters when examining the inversion-recovery sequence of other parts of the body and search for similar by the proton density of tissues in any organ and department of the skeleton, in each group of lymph nodes and in brain tissue.

An example of a specific implementation of the "Method for the diagnosis of micrometastases of malignant tumors."

Patient Pozdnyakov Vyacheslav Ivanovich 03/04/1949

Map 23159 / date of study

12/01/2009

Sick since September 2009, when he first noted the growing pain in the lower back, subfebrile condition. He was treated by a neurologist at the place of residence without effect.

An MRI scan of the abdomen and pelvis was performed.

Research sequence parameters: IR, TR5860 TE45.6 slice 8mm, IR, TR4500 TE45.6 slice 8mm, IR, TR3000 TE100.2 slice 8mm (optimal image), IR, TR6000 TE63.8 slice 8mm. Identified multiple metastatic foci in the bones of the skeleton (chest, lumbar vertebrae, pelvic bones, femurs) ranging in size from 0.2 cm to 3.4 cm.

When performing SRT in the right lung in S2, a peripheral tumor node of 3 × 3 cm, enlarged bronchopulmonary lymph nodes were revealed.

Diagnosis: peripheral cancer of the right lung, T3NxM1, metastatic bone damage st.4 gr 2.

The patient was prescribed conservative treatment (polychemotherapy).

The technical and economic efficiency of the "Method for the diagnosis of malignant tumor micrometastases" lies in the possibility of differential diagnosis of lymphadenopathy, reactively changed lymph nodes from lymph nodes filled with tumor cells. In the developed imaging method, metastatic lymph nodes lose the inherent normal and reactive lymph nodes division into zones, acquire a hyper-intense signal. The data obtained by applying this sequence are confirmed morphologically with lymphodissection and are important for the selection of the lymph node for a puncture biopsy. The resulting images are used to determine micrometastasis and document the extent of the tumor process. The application of the method does not require contrast enhancement.

Claims (1)

A method for the diagnosis of micrometastases of malignant tumors, including magnetic resonance imaging, characterized in that after identifying a portion of pathological tissue: primary tumor, metastatic lymph node, distant metastasis, the TE parameters are changed — echo time and TR — recovery time in the inversion-recovery sequence with a short T1 , until a series of clear magnetic resonance images are obtained, in which, against the background of a suppressed signal from normal surrounding tissues, hyperintensive tumor tissue is determined, laying search sequences with a minimum number of slices, the achieved level of the magnetic resonance signal corresponds to the histological type of the tumor, subsequently reproducing the parameters TE echo time and TR recovery time when studying the inversion-restoration sequence of other parts of the body and search for tissues similar in proton density in any organ and skeleton, in each group of lymph nodes and in brain tissue.