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80MAGNETIC-RESONANCE IMAGING IN THE DIAGNOSIS OF BREAST CANCER AND ITS METASTASIS TO THE SPINAL COLUMN
Dilrukh Ilkhomovna Khodjaeva
Bukhara State Medical Institute
ABSTRACT
MRI data of the spine of 56 patients with a verified diagnosis of breast cancer were analyzed. Indications for magnetic resonance imaging were X-ray data, osteoscintigraphy, and the presence of a clinical picture. Based on the results of the study, we can conclude that there is no specific MR semiotics of metastatic bone damage in various types of infiltrative breast cancer. The level of lesion, the depth of invasion, the presence of bone-destructive changes, the degree of spread to soft tissues are fully reflected in BbicoKononbHoft MaraHTH0pe30HaHCH0Hhigh-field magnetic resonance imaging, which is confirmed by pathoanatomical data.
Keywords: MRI, breast cancer, spinal column, metastases.
Introduction Breast cancer is one of the most common malignancies in women. The incidence of breast cancer increases with age (as a rule, tumors occur after 35-40 years, the peak incidence is recorded in women aged 60-65 years). In all countries of the world, the incidence and mortality of women from breast cancer have increased over the past decade. The highest standardized rates of breast cancer are reported in the United States, where breast cancer accounts for 32% of all newly diagnosed cancer cases in women. The risk of developing invasive cancer in the course of life is 12.6% (in every eighth woman). According to some authors, breast cancer metastasizes to the bone in 45-80% of cases. Such a large range is due to various morphological forms of cancer, the duration of the course, as well as the timing of treatment initiation. The most frequently affected areas are the lumbar (59%) and thoracic (57%) spine, pelvic bones (49%) and ribs (30%), i.e. the bones of the axial skeleton are mainly involved in the process. In approximately 15% of patients, bone metastases are the only manifestation of the disease. The predisposition of some tumors (breast and prostate) to metastasize to the bones of the axial skeleton is explained by the presence of the veno-vertebral plexus, which receives blood from the breast and pelvic cavity. This plexus is characterized by the absence of valves, basal membranes in the bone marrow vessels, and low intravascular pressure, which creates favorable conditions for extravasation of tumor cells [2]. Bone tissue in the human body is in a dynamic equilibrium of alternating resorption and bone formation, this state is maintained by cells that destroy bone tissue(osteoclasts) and the cells that create it (osteoblasts). Regulation of this process occurs due to the influence of the endocrine system (parathyroid glands). In accordance
with this, there are three types of bone metastases: osteoblastic (sclerotic), osteoclastic (lytic) and mixed form. The most common type of metastasis in breast cancer is osteolytic, but mixed forms are also quite common. The spread of metastases occurs hematogenically. The cancer cell enters the small circle of blood circulation through the veno-vertebral tubes. plexuses. Once trapped in the capillaries of the bone marrow, the cell easily migrates to the bone due to the lack of a basement membrane in these capillaries and the low blood flow rate in this area. With the further development of metastatic embolus происходит экспрессия , paracrine factors are expressed, among which паратиреоидподобныйparathyroid-like hormone (PTH), which stimulates bone resorption, is of particular importance. Bone resorption does not occur directly, but indirectly [3-8]. PTPG receptors are located on osteoblasts, which, in turn, интерлейкинов, колониестимулирующегоactivate osteoclasts and progenitor cells by releasing interleukins, macrophage colony-stimulating factor, and other factors. PTPG was discovered as a result of the search for factors secreted by tumor cells into the blood, which are the cause of the most common metabolic disorder in cancer diseases — hypercalcemia. Currently, the role of PTPH in the development of hypercalcemia as a causal factor of metastasis (in particular, to bone) in the development of osteolysis in metastases is being investigated. To date, PTPG has been isolated from breast cancer cells, bladder cancer, squamous cell lung cancer, and kidney cancer, i.e., the tumors most often complicated by the development of hypercalcemia. Breast cancer cells secrete PTPG in 50-60% of cases. Systemic administration of PTPG reproduced most of the effects of hypercalcemia and primary hyperparathyroidism — increased calcium content, phosphaturia, increased cyclic AMP excretion, increased tubular реабсорбцииcalcium reabsorption, increased osteoclast activity, and increased vitamin D production. At the same time, a number of studies have shown that the introduction of antibodies to PTPG did not completely level hypercalcemia, which indicated the involvementof other mechanisms in pathogenesis [3]. Thus, there is strong evidence that breast cancer cells produce factors that activate osteoclasts, which cause bone resorption; in this case, cytokines and growth factors are released, which, in turn, stimulate the proliferation of tumor cells. This creates a "vicious circle".
Objective: To evaluate the possibilities высокопольнойof high-field magnetic resonance imaging in detecting secondary lesions of the vertebral bodies and pelvic bones in breast cancer. Within the framework of this goal, the following tasks were solved. 1. Evaluate the possibility and effectiveness of a high-fieldвысокопольной MRI in the diagnosis of secondary lesions of the spine, pelvic bones in breast cancer. 2. To identify the signs of secondary damage to the spine and pelvic bones characteristic of various morphological types of breast cancer according to MRI data. and" 58 patients with a verified diagnosis of breast cancer were examined. Histological types of tumors were: infiltrating ductal cancer-44 (64%), infiltrating lobular cancer - 22 (33%),
infiltrating ductal cancer with a predominance of the intraductal component 2 (3%). Indications for magnetic resonance imaging were X-ray data, osteoscintigraphy, and the presence of a clinical picture. The most frequent complaints (symptoms) were pain in the area of metastatic lesion in the projection of a particular spine, in the pelvic bones, in 35% of cases there were combined localizations. Magnetic resonance imaging was performed on Bbic0K0n0ttbH0Ma high-field tomograph "Signa" with a magnetic field strength of 1.5 tesla. Scanning was performed in the patient's supine position according to the standard program with obtaining T1, T2 weighted images in FSE sequences in axial, sagittal, and frontal projections, with a slice thickness and an inter-slice interval of 5 mm. The study was necessarily supplemented with a program with signal suppression from adipose tissue (FatSat). In some cases, high doses of paramagnet (40-60 ml) were administered intravenously to the patient to clarify the diagnosis, assess the local prevalence of the process, and obtain other additional diagnostic information. Analysis of the material and discussion of the study results Analysis of magnetic resonance imaging data showed that osteolyticand sometimes mixed types of metastatic bone damage are more common in breast cancer. The osteolytic type is characterized by hypointensive MR signal from the bone marrow in T1VI. In the mode of suppression of the signal from adipose tissue, as well as in the T2VI mode, a mixed heterogeneous signal was most often observed (71%), with small lesions, a high signal intensity was determined. Note that although most bone metastases in breast cancer are inherently osteolytic, often in the late stages of the disease, as well as the highly aggressive nature of growth, there is a soft-tissue component that spreads to the surrounding tissues, including the spinal canal (Fig.
Figure 1. Infiltrative lobular breast cancer. Condition after complex treatment. Magnetic resonance imaging of the thoracic spine, sagittal projection. A) T2VI -multiple focal lesion of the thoracic vertebral bodies, total diffuse lesion of the Th12 body, with partial destruction of the upper and lower cortical plate. B) FatSat - low-hyperintensive MR signal from the affected vertebral bodies, mixed signal from the
Th12 body. On post-contrast images, the spread of the soft-tissue component to surrounding tissues, the depth of invasion, and the ratio with unchanged soft tissues are more clearly visualized. A characteristic feature of a metastatic lesion is the so-called "equalization phenomenon", when the hypointensive signal from the affected vertebra after intravenous contrast becomes isointensive in relation to the bodies of unchanged vertebrae [9-16]. This effect is most likely a reflection of pathological vascularization, which is characteristic of the malignant nature of the changes. It should also be noted that the introduction of a paramagnetic material does not affect the visualization of the initially hyperintense masses on T1BH, such as, for example, hemangioma, areas of fatty involution of the bone marrow hyperintense masses on T1BH, such as, for example, hemangioma, areas of fatty involution of the bone marrow (Fig. With the aim of obtaining additional information about the nature of metastatic changes, as well as data mapping magnetic resonance imaging with morphological picture held sectional analysis of 5 large dead with a diagnosis of infiltrative breast cancer. The preparations were used to visualize foci of bone destruction in the vertebral bodies, with the destruction of m / n discs, end plates, in 3 cases the presence of an extravertebral soft-tissue component with randomly located bone inclusions was noted (Fig. 4). When comparing the degree of prevalence and nature of the tumor lesion, the MRI data in all cases coincided with the data of a pathoanatomical autopsy. Metastasis of infiltrative cancer in the bodies of 4 and 5 thoracic vertebrae. Macropreparation, frontal cutting of the spinal column. Foci of lytic destruction of the spongy substance of the vertebral bodies. Destruction of the intervertebral disc [17-22]. Compression pathological fracture of the 5th vertebra. Fibrosis of the posterior longitudinal ligament. B) Sagittal cutting of the spinal column. Compression fracture. Rupture of the anterior longitudinal ligament at the attachment point of the m / n disk. Go to the article's table of contentsConclusions Based on the results of the study, we can conclude that there is no specific MR semiotics of metastatic bone damage in various types of infiltrative breast cancer. The level of lesion, the depth of invasion, the presence of bone-destructive changes, the degree of spread to soft tissues are fully reflected in BbicoKononbHonhigh-field magnetic resonance imaging, which is confirmed by pathoanatomical data. This effect is most likely a reflection of pathological vascularization, which is characteristic of the malignant nature of the changes. It should also be noted that the introduction of a paramagnet does not affect the visualization of initially hyperintensive formations on the T1VI, such as, for example, hemangioma, areas of fat involution of the bone marrow (Fig. 2) hyperintensive formations on the T1VI, such as, for example, hemangioma, areasof fat involution of the bone marrow.. Infiltrativeductal breast cancer. Magnetic resonance imaging of the lumbar spine, sagittal projection. Metastatic lesion of the 5th lumbar vertebra. A)T2VI - hypointensive diffuse signal in the L5 body, corresponding to a metastatic lesion. Bodies L1, L2, and L3 have hyperintensive
rounded foci. B) FatSat-hyperintensive MR signal in the L5 body, which occupies the entire vertebral body. Isointensive signal in the body L2-fat involution of the bone marrow. In the bodies L1, L3 hyperintensive foci-hemangiomas. C) T1VI. Diffuse hypointensive MR signal from the L5 vertebra. Hyperintensive foci in L1, L3 -hemangiomas, in the body L2-fat involution of the bone marrow. D) T1VI +S. Paramagnetic accumulation is observed in the L5 body, a "signal equalization phenomenon". Hemangioma in the L1 body - contrast enhancement, in the L3 body-hyperintensive The MR signal remains unchanged [23-29]. Artifacts from movement caused by pain syndrome. Compression fractures in 6 patients (9%) showed the presence of a mixed bone-soft tissue component due to randomly located areas of destroyed bone, as well as bone inclusions as a result of the reparative action of osteoblasts against the background of proliferative activity of tumor cells. With the metastatic nature of the fracture, there is often a discrepancy between the reduced body height and the severity of the soft-tissue component, which indicates the presence of an additional tumor component "plus-tissue" (Fig.3). A B C Figure 3. Infiltrative lobular breast cancer. Magnetic resonance imaging, metastatic lesion of the spine. A) T2VI, sagittal plane. Pathological fracture of the Th10, L2 vertebrae with the spread of the process to the paravertebral tissues. Multiple focal lesions of the vertebral bodies. B) Lower-thoracic upper-lumbar spine, T2VI, coronal plane. Pathological fracture of the Th10, L2 vertebrae with the presence of a soft-tissue component. C) T2VI, axial plane, level Th10. Pathological fracture of the vertebral body, with the spread of the tumor process into the spinal canal, to the paravertebral tissues on the right, damage to the right spinous process, the right costal-vertebral joint. In order to obtain additional information about the nature of metastatic changes, as well as to compare the data of magnetic resonance imaging with the morphological picture, a sectional analysis of 5 deceased patients with a diagnosis of infiltrative breast cancer was performed. On the preparations, foci of bone destruction in the vertebral bodies were visualized, with the destruction of m / n discs, end plates, and in 3 cases the presence of extravertebral damage was noted. When comparing the degree of prevalence and nature of the tumor lesion, the MRI data in all cases coincided with the data of the pathoanatomical autopsy.. A) Metastasis of infiltrative cancer in the bodies of 4 and 5 thoracic vertebrae. Macropreparation, frontal cutting of the spinal column. Foci of lytic destruction of the spongy substance of the vertebral bodies. Destruction of the intervertebral disc. Compression pathological fracture of the 5th vertebra. Fibrosis of the posterior longitudinal ligament. B) Sagittal cutting of the spinal column. Compression fracture. Rupture of the anterior longitudinal ligament at the attachment point of the m / n disk. Conclusions Based on the results of the study, we can conclude that there is no specific MR semiotics of metastatic bone damage in various types of infiltrative breast cancer. The level of lesion, the depth of invasion, the presence of bone-destructive changes, the
degree of spread to soft tissues are fully reflected in BbicoKononbHonhigh-field magnetic resonance imaging, which is confirmed by pathoanatomical data. Go to the table of contents
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