Akut iskemik strok hastalarında cavalieri prensibi ve klasik yöntem ile ölçülen strok hacimlerinin karşılaştırılması
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Date
2018
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Düzce Üniversitesi
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info:eu-repo/semantics/openAccess
Abstract
Giriş ve Amaç: Serebral iskemi, beynin belli bir alanında kan akımının normal beyin fonksiyonlarını sürdürmek için ihtiyaç duyulan düzeyin altına düşmesi sonucu oluşan, tanısı klinik ve görüntüleme ile konulan bir tablodur. Radyolojik görüntülemelerde birçok hacim ölçüm yöntemi kullanılmaktadır, bu yöntemlerden en sık kullanılan Klasik Yöntem olarak bilinen formülle hacim ölçümü yöntemidir. Bu çalışmada daha çok deneysel çalışmalarda kullanılan, klinik kullanımı az olan Cavalieri prensibi ile ölçülen hacim ve Klasik Yöntem'le ölçülen hacim karşılaştırılmıştır. Gereç ve Yöntem: Düzce Üniversitesi Araştırma ve Uygulama Hastanesi Acil Servisi'ne başvuran 18 yaş üstü, difüzyon MRG çekilen ve akut iskemik strok tanısı konmuş toplam 44 olgu çalışmaya dahil edilmiştir. Çalışmamız prospektif bir kesitsel çalışma olarak tasarlanmıştır. Akut iskemik strok tanısı alanlarda Hitachi Echelon 1,5 Tesla marka MR cihazıyla gapsiz ve devamlı T2 sekansında difüzyon görüntüleme alınmıştır. Elde edilen görüntülerden hem Cavalieri Prensibi ve Klasik Yöntem'le yapılan enfarkt hacmi ölçümleri, hem de hastanın klinik durumu ile enfarkt hacminin büyüklüğü karşılaştırılıp analiz edilmiştir. Bulgular: Bilinci açık olan hastaların Klasik Yöntem'le ölçülen enfarkt hacmi ortalaması (1,06±1,40 cm³) Cavalieri Prensibi ile ölçülen ortalamadan (0,97 ±1,33 cm³) anlamlı düzeyde yüksek bulunmuştur (p< 0,001). Hem sağ hem de sol güç kaybı olan hastalarda Klasik Yöntem'le hesaplanan enfarkt hacminin ortalaması (sağ: 2,50 ±3,98 cm³; sol: 1,61 ±2,35 cm³) Cavalieri Prensibi ile hesaplanan ortalamadan (sağ: 2,41 ±4,08; sol: 1,51±2,24) anlamlı şekilde yüksektir (p< 0,005). Sağ hemiplejik hastalarda yaş ile Klasik Yöntem arasında pozitif yönde zayıf bir korrelasyon olduğu iii görülmüştür (r: 0,406). Hastaların tamamında GKS ile NIHS skoru arasında negatif yönde kuvvetli bir ilişki saptanmıştır(r: -0,705). İnfarkt hacmi Cavalieri Yöntemi'nde Klasik Yöntem'e kıyasla daha düşük çıkmıştır. Bilinci kapalı olanlarda ve uykuya meyilli olanlarda infarkt hacmi, bilinci açık olanlara kıyasla daha yüksek bulunmuştur. İleri yaşlarda (80 yaş ve üstü) infarkt alanı daha genç hastalara göre daha yüksek saptanmıştır. Sonuç: Çalışmamızda Cavalieri yönteminin hastalar için daha iyimser sonuçlar verdiği saptanmıştır. Bu tür yöntemlerin hangisinin daha doğru ölçümler yaptığının saptanması için kadavra çalışmaları, hayvan deneyleri ya da klinik olarak yapılacak uzun dönemli çalışmalara ihtiyaç duyulmaktadır.
Introduction and Objectives: Cerebral ischemia is a clinical condition which occurs when blood flow in a specific area of brain drops below the level needed for maintanence of normal cerebral fuctions, and is diagnosed using clinical features and imaging findings. Several volume measurement methods are used in radiological imaging; the most common one is Clasical Method which depends on measurement of the volume using a formula. In this study, the volume measured using the Cavalieri principle which is mostly used in experimental studies and has less clinical use is compared with the one measured with the Classical method. Materials and Methods: A total of 44 patients above 18 years of age who were admitted to Düzce University Hospital Emergency Department and diagnosed with acute ischemic stroke after having diffusion-weighted MRI were included in the study. This study was designed as a prospective case study. Continuous and gapless diffusion-weighted MRI in T2 sequence was performed with HITACHI Echelon 1.5 Tesla MRI device. Infarct volumes measured with the Classical Method and the Cavalieri Priciple were compared. Besides, the relationship between the clinical condition of the patient and the size of infact volume was evaluated. Results: The mean infarct volume calculated with the Classical Method (1.06 ± 1.40 cm³) was significantly higher than the one measured with the Cavalleri Principle (.97 ± 1.33 cm³) in conscious patients (p <.001). The mean infarct volume calculated with the Classical Method (right: 2.50 ± 3,98 cm³; left: 1.61 ± 2.35 cm³) was found to be significantly higher than that measured using the Cavalieri Principle (right: 2.41 ± 4.08 cm³; left: 1.51 ± 2.24 cm³) in patients with both right-sided and left-sided muscle v weakness (p <.005). There was a weak correlation between age and infarct volume measured with the Classical Method in patients with right-sided hemiplegia (r: .406). A strong negative correlation between GCS score and NIHS score was found in all patients (r: -.705). Infarct volume measured with the Cavalieri Principle was found to be lower than the one calculated with the Classical Method. Mean infarct volume of the unconscious patients and lethargic patients were found to be higher than that of the conscious patients. Infarct volume of the elderly patients (80 years of age or older) was higher than that of younger patients. Conclusion: The Cavalieri method has been found to give more optimistic results for patients. Cadaver studies, animal experiments or long-term clinical trials are needed to determine which of these methods make more accurate measurements.
Introduction and Objectives: Cerebral ischemia is a clinical condition which occurs when blood flow in a specific area of brain drops below the level needed for maintanence of normal cerebral fuctions, and is diagnosed using clinical features and imaging findings. Several volume measurement methods are used in radiological imaging; the most common one is Clasical Method which depends on measurement of the volume using a formula. In this study, the volume measured using the Cavalieri principle which is mostly used in experimental studies and has less clinical use is compared with the one measured with the Classical method. Materials and Methods: A total of 44 patients above 18 years of age who were admitted to Düzce University Hospital Emergency Department and diagnosed with acute ischemic stroke after having diffusion-weighted MRI were included in the study. This study was designed as a prospective case study. Continuous and gapless diffusion-weighted MRI in T2 sequence was performed with HITACHI Echelon 1.5 Tesla MRI device. Infarct volumes measured with the Classical Method and the Cavalieri Priciple were compared. Besides, the relationship between the clinical condition of the patient and the size of infact volume was evaluated. Results: The mean infarct volume calculated with the Classical Method (1.06 ± 1.40 cm³) was significantly higher than the one measured with the Cavalleri Principle (.97 ± 1.33 cm³) in conscious patients (p <.001). The mean infarct volume calculated with the Classical Method (right: 2.50 ± 3,98 cm³; left: 1.61 ± 2.35 cm³) was found to be significantly higher than that measured using the Cavalieri Principle (right: 2.41 ± 4.08 cm³; left: 1.51 ± 2.24 cm³) in patients with both right-sided and left-sided muscle v weakness (p <.005). There was a weak correlation between age and infarct volume measured with the Classical Method in patients with right-sided hemiplegia (r: .406). A strong negative correlation between GCS score and NIHS score was found in all patients (r: -.705). Infarct volume measured with the Cavalieri Principle was found to be lower than the one calculated with the Classical Method. Mean infarct volume of the unconscious patients and lethargic patients were found to be higher than that of the conscious patients. Infarct volume of the elderly patients (80 years of age or older) was higher than that of younger patients. Conclusion: The Cavalieri method has been found to give more optimistic results for patients. Cadaver studies, animal experiments or long-term clinical trials are needed to determine which of these methods make more accurate measurements.
Description
YÖK Tez No: 489990
Keywords
İlk ve Acil Yardım, Emergency and First Aid, Beyin, Brain, Cavalieri prensibi, Cavalieri principle, Serebral enfarktüs, Cerebral infarction, İnme, Stroke, İskemi, Ischemia, İskemik atak-geçici, Ischemic attack-transient, Cavalieri Yöntemi, Klasik Yöntem, İnfarkt, Beyin, İnme, Cavalieri Method, Classical Method, Infarct, Brain, Stroke
