KESESUAIAN INTERPRETASIDIFFUSEFATTYLIVERPADA USGGREY-SCALEDIBANDINGKAN CT-SCAN NON-KONTRAS PADA PASIEN CA MAMMAE YANG MENDAPATTERAPIHORMONAL

R. DUDDY ARI HARDIAN, Prof.dr. Arif Faisal, Sp.Rad (K),DHSM; dr. Sri RetnaDwidanarti, Sp.Rad (K) Onk

2016 | Tesis-Spesialis | SP RADIOLOGI

Latar belakang. Fatty liver disebut sebagai “ silent “ liver disease dapat berhubungandengan alkohol dan non-alkohol. Penggunaan terapi hormonal pada pasien dengan Camammae sekitar 43 % mendapatkan efek samping berupa fatty liver.Fatty liver yang diinduksi pemberian terapi hormonal termasuk dalam kelompok non-alcoholic fatty liverdisease(NAFLD), Penyakit tersebut dapat berkembang menjadi fibrosis, cirrhosis danhepatic insufficiency.Pola penumpukan lemakdiffusepaling sering ditemukan. Biopsi livermerupakan pemeriksaan gold standar diagnosis NAFLD, bersifat invasif yang memilikiresiko perdarahan sehingga diperlukan pemeriksaan non invasif sebagai alternatif. ModalitasUSGgrey-scaledan CT-scan non-kontras dapat digunakan sebagai alternatif pemeriksaanuntuk diagnosis fatty liver dengan menggunakan beberapa parameter untuk meningkatkankeakuratan masing-masing modalitas dalam mendiagnosis dan selanjutnya dapatmenentukan gradenya. Berkaitan dengan hal tersebut maka penelitian ini bertujuan untukmengetahui kesesuaian fatty liverdan uji kesesuaiangrade fatty liverCT-scan non-kontrasdengan USG.Bahan dan cara. Penelitian ini menggunakan desain penelitian uji kesesuaian cross-sectional non eksperimental dengan pengambilan sampel retrospektif (data CT-scan non-kontras) dan prospektif (data USG) yang dilakukan di Instalasi Radiologi RSUP Dr. Sardjito.Subyek penelitian ini adalahpenderita Ca mammae yang telah mendapat terapi hormonalyang menjalani follow up pemeriksaan CT-scan abdomen non-kontras dan USGtransabdominal.Subyek penelitian diamati oleh seorang dokter spesialis radiologi denganpengalaman lebih dari lima tahun menginterpretasi hasil USG abdomen. Dari hasilinterpretasi dokter spesialis radiologi dilakukan uji kesesuaian fatty liverdan uji kesesuaiangradefattyliverCT-scan non-kontras dengan USG menggunakan analisis statistikMc Nemardan untuk mengetahui nilai kesesuaiannya dianalisiskappa.Hasil.Penelitian didapatkan subyek penelitian sebanyak 30 sampel dengandiffuse fatty liversebanyak 5 dannondiffusefatty liversebanyak 25 berdasarkan interpretasiobserver. Pada ujiMc Nemarantara interpretasi diffuse fatty liverpemeriksaan USGgrey-scaledibandingkanCT-scan non-kontras didapatkan hasil p = 1 ; p > 0,05 berarti terdapat kesesuaian yangbermakna secara statistik, dengan nilai kesesuaiankappainter-observer= 1 yang berarti baik.Kesimpulan.Terdapat kesesuaian antara interpretasi diffuse fatty liver pada pemeriksaanUSGgrey-scaledengan CT-scan non-kontras, dengan nilai kesesuaian yang baik. Namunbelum dapat kesesuaian secara statistik padagradediffusefatty liver.Terdapat korelasi antarakejadian diffuse fatty liver dengan lama terapi hormonal, walaupun kekuatan korelasinyasangat buruk.Tidak didapatkan korelasi antara kejadiandiffusefatty liverdengan peningkatankadar SGOT dan SGPT

Background. Fatty liver is referred to as "silent" liver disease may be associated withalcoholic and non-alcoholic. The use of hormonal therapy in patients with breast Ca about43% get side effects such as fatty liver. Fatty liver is induced hormonal therapy belongs to agroup of non-alcoholic fatty liver disease (NAFLD), the disease can progress to fibrosis,cirrhosis and hepatic insufficiency. The pattern of diffuse buildup of fat is most often found.Liver biopsy is the gold standard examination NAFLD diagnosis, invasive that have a risk ofbleeding that required non-invasive examination as an alternative. The modalities ofultrasound and CT-scan non-contrast can be used as an alternative examination for diagnosisof fatty liver by using multiple parameters to improve the accuracy of each modality in thediagnosis and can further determine the grade. In this regard, this study aims to determine thesuitability of fatty liver and fatty liver conformance test grade CT-scan non-contrastultrasound.Material and methods. , This study research design conformance test cross-sectional non-experimental with retrospective sampling (CT-scan non-contrast data) and prospective(Ultrasound data) were performed in the Radiology department of Dr. Sardjito. Subjects ofthis study were patients who had received breast Ca hormonal therapy who underwentfollow-up CT scan of the abdomen non-contrast and transabdominal ultrasound. The researchsubjects were observed by a specialist radiologist with experience of more than five years ofinterpreting the results of abdominal ultrasound. From the interpretation of radiologyspecialists to test the suitability of fatty liver and fatty liver conformance test grade CT-scannon-contrast ultrasound using Mc Nemar statistical analysis and analyzed to determine thesuitability kappa value.Results. Research showed research subjects were 30 samples 30 samples with diffuse fattyliver as much as 5 and nondiffusefatty liveras much as 25 based on the interpretation of theobserver. At the Mc Nemar test between the interpretation ofdiffuse fatty liver gray-scaleultrasound examinationcomparednon-contrast CT scan showedp = 1; p> 0.05 means thatthere is a statistically significant conformity with suitability kappa value intra-observer = 1,which means good.Conclusion.There is acorrespondence between the interpretation of diffuse fatty liver ongrey-scale ultrasound examination with non-contrast CT scan, with suitability good value.But can not be statistically conformity in grade diffuse fatty liver. There is a correlationbetween the incidence ofdiffuse fatty liver with long hormonal therapy, although the strengthof the correlation is very bad. No correlation between the incidence of diffuse fatty liver withelevated levels of SGOT and SGPT.

Kata Kunci : Non alcoholic fatty liver disease; Fibrosis; Cirrhosis; Hepatic insufficiency; Fattyliver