Tesis

Hubungan Nilai Apparent Diffusion Coefficient Dengan Derajat Edema Peritumoral Glioblastoma Pada Pemeriksaan Magnetic Resonance Imaging Kepala Serta Faktor-Faktor Yang Memengaruhinya Di RSUPN Dr. Cipto Mangunkusumo = Correlation Between Apparent Diffusion Coefficient Value and Degree of Peritumoral Edema in Glioblastoma on Head Magnetic Resonance Imaging Examination and Its Influencing Factors at RSUPN Dr. Cipto Mangunkusumo.

Latar Belakang: Edema peritumoral kerap dihubungkan dengan munculnya berbagai defisit neurologis dan progresivitas pada glioblasoma. Peran nilai Apparent Diffusion Coefficient (ADC) pada pemeriksaan Magnetic Resonance Imaging (MRI) kepala, faktor demografi (usia, jenis kelamin) dan gejala klinis (sakit kepala, penurunan kesadaran dan papil edema) dalam memrediksi derajat edema peritumoral masih belum banyak diketahui, sehingga diperlukan telaah lebih lanjut. Tujuan penelitian ini untuk melihat hubungan nilai ADC intratumoral, faktor demografi dan gejala klinis dengan derajat edema peritumoral. Metode: Penelitian ini menggunakan desain crossectional dengan data sekunder di RSUPN Dr. Cipto Mangunkusumo pada tahun 2014-2022. Seluruh sampel memiliki hasil histopatologi dan hasil pemeriksaan MRI kepala dengan sekuens diffusion weighted imaging (DWI) dan ADC. Dilakukan analsis terhadap derajat edema peritumoral dengan nilai ACD intratunoral, faktor demografi dan gejala klinis. Setiap variabel bebas dan tergantung dianalisis secara bivariat menggunakan uji Chi-square; untuk variabel bebas dengan nilai p < 0,25 dilakukan analisis multivariat. Derajat edema peritumoral pada MRI dibagi menjadi mayor ( > 1 cm) dan minor ( < 1cm). Hasil: Sebanyak 78 subjek, mayoritas laki-laki (62,8%) dengan usia rerata 46,1±13,9 tahun. Gejala klinis tersering berupa nyeri kepala (91%), penurunan kesadaran (64,1%) dan papil edema (35,5%) dengan mayoritas subjek menderita edema mayor (83,3%) dengan nilai ADC minimal ≤ 0,75 x 10-3 mm2/s (60,3%). Analisis bivariat menujukkan hubungan bermakna antara derajat edema peritumoral dengan nilai ADC minimal (p < 0,001). Kelompok usia ≤ 60 tahun, jenis kelamin, penurunan kesadaran dan papil edema tidak berhubungan terhadap derajat edema peritumoral. Pada penelitian ini, (100% usia di > 60 tahun mengalami edema mayor. Subjek dengan nilai ADC minimal ≤ 0,75 x 10-3 mm2/s memiliki OR 11,32 (2,54-56,88) kali lebih tinggi untuk mengalami edema mayor dibanding nilai ADC minimal > 0,75 x 10-3 mm2/s. Kesimpulan: Pasien dengan nilai ADC minimal intratumoral ≤ 0,75 x 10-3 mm2/s memiliki kemungkinan lebih besar menderita edema mayor. Tidak terdapat hubungan antara derajat edema peritumoral dengan usia ≤ 60 tahun, jenis kelamin, nyeri kepala, tingkat kesadaran dan papil edema, namun pasien > 60 tahun, mutlak mengalami edema mayor.
Kata kunci: Glioblastoma, derajat edema peritumoral, nilai ADC minimal, MRI



Background: Glioblastoma is the most common primary brain malignancy with highest mortality rate. The various clinical manifestations shown as a result of increasing of intracranial pressure caused by tumors and peritumoral edema. The minimumum apparent diffusion coefficient (ADC) value on intratumoral magnetic resonance imaging (MRI) examination played an important role in assessing the prognosis of a glioblastoma, but the relationship between the intratumoral ADC value and the degree of peritumoral edema, has never been studied before. This study aims to assess the relationship between the degree of peritumoral edema and the minimum ADC value as well as the influencing factors in the form of demographics and the most clinical symptoms namely age, gender, headache, decreased consciousness and papilledema. Method: A crossectional study using secondary data at Dr. Cipto Mangunkusumo Hospital in 2014-2022. All samples had histopathological and head MRI examination results with weighted imaging (DWI) and ADC diffusion sequences. Analysis of the degree of peritumoral edema with intratunoral ACD values, demographic factors and clinical symptoms is performed. Each independent and dependent variable was analyzed bivariately using the Chi-square test; For independent variables with a value of p < 0.25 a multivariate analysis was performed. The degree of peritumoral edema in MRI is divided into major ( > 1cm) and minor ( ≤ 1cm). Result: We found 78 subjects which mostly were men (62.8%) with an average age of 46.1±13.9 years. The most frequent clinical symptoms were headache (91%), loss of consciousness (64.1%) and papill edema (35.5%) with the majority of subjects suffering from major edema (83.3%) with an ADC value of at least ≤ 0.75 x 10-3 mm2/s (60.3%). Bivariate analysis showed the associated between peritumoral edema degrees and minimal ADC values (p < 0.001). The age group ≤ 60 years, gender, loss of consciousness and papillary edema are not associated with the degree of peritumoral edema. In this study, (100% of the age at > 60 years had major edema. Subjects with an ADC value of at least ≤ 0.75 x 10-3 mm2/s had an OR of 11.32 (2.54-56.88) times higher for major edema than an ADC value of at least > 0.75 x 10-3 mm2/s. Conclusion: Subjects with minimal intratumoral ADC values of ≤ 0.75 x 10-3 mm2/s have a greater likelihood of suffering from major edema. There was no association between the degree of peritumoral edema and the age of ≤ 60 years, gender, headache, level of consciousness and papill edema, but patients > 60 years, absolutely had major edema.
Key words : Glioblastoma, nilai ADC minimal, derajat edema peritumoral, MRI