jurnal reading a (indonesia)

7/23/2019 Jurnal Reading a (Indonesia)

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UTILITY POSTMORTEM OTOPSI PADA PENCITRAAN SELURUH TUBUH: PENGAMATAN

AWAL MEMBANDINGKAN MDCT DAN 3.0T MRI DENGAN TEMUAN OTOPSI

Tujuan: Kami !"#$%&i' (i)an(in*%an mu+&i($&$,&"! #$+u!u- &u)u- ,"mu&$(

&"m"*!a- /MDCT (an ma*n$&i, !$#"nan,$ 3.0T /MR *am)a! ($n*an &$muan

"&"#i. Ba-an (an M$&"($: Lima maa& m$nja(i #a#a!an #$+u!u- &u)u-1 24 #a+u!anMDCT (an 3.0T MR $n,i&!aan (a+am 5a%&u (ua jam #$)$+um "&"#i. S$)ua- "+"*i#&

!a(i%a+ (i%+a#i6%a#i%an MDCT (an 3.0T MRI &$muan %$ &$muan )$#a! (an %$,i+1 an*

(i)an(in*%an ($n*an &$muan "&"#i.

Ha#i+: S$)a*ian )$#a! &$muan $n,i&!aan1 an* )$!%ai&an ($n*an %$a+a (an +$-$!1

jan&un* (an $m)u+u- (a!a-1 (a(a1 $!u&1 &u+an* )$+a%an*1 (an +$#i

mu#%u+"#%$+$&a+1 )$!-u)un*an ($n*an &$muan "&"#i. P$n$)a) %$ma&ian an*

(i&$n&u%an ($n*an (a#a! &$muan MRI MDCT (an 3.0T an* %"n#i#&$n ($n*an

&$muan "&"#i (a+am $ma& (a!i +ima %a#u#. CT )$!*una (a+am m$n(ia*n"#i#

$!(a!a-an 'a&a+ (an n$um"&"!a%#1 #$!&a m$n$n&u%an )$n&u% (an %a!a%&$!i#&i%

(a!i a&a- &u+an* (an a!a-an (a!i %$%ua&an $%#&$!na+. MRI $'$%&i' (a+amm$n*$7a+ua#i (an m$n$+u#u!i !u&$ (a!i )$n(a +"*am1 +$#i ja!in*an +una%1 %!"ni#i&a#

$!(a!a-an1 (an m$ma! &u+an*.

K$#imu+an: S$)ua- MDCT "#&m"!&$m (i%"m)ina#i%an ($n*an MRI a(a+a- a+a&

)$!"&$n#i %ua&1 m$n$(ia%an $n*u%u!an n"n4in7a#i' (an ")$%&i' un&u%

m$+a%u%an $n$+i(i%an '"!$n#i%.

I+mu '"!$n#i% &$+a- maju (a+am )$)$!aa )i(an*1 &$!ma#u% *$n$&i%a1 m$&"($

$n$+i(i%an TKP1 (an &"%#i%"+"*i /2. S$)a+i%na1 "&"#i ma#i- m$n**una%an

m$&"($ &!a(i#i"na+1 &$!ma#u% $m)$(a-an maa&1 ($#%!i#i +i#an1 '"&"*!a6 &u)u-1

(an ("%um$n&a#i &$!&u+i# (a!i &$muan /8. Namun1 "&"#i %"n7$n#i"na+ m$mi+i%i

)ana% %$&$!)a&a#an &$!ma#u% #u)j$%&i7i&a#1 %u!an*na !$!"(u%#i)i+i&a#1

$m)a&a#an m$n$+i(i%i #$+u!u- &u)u- (an %$&i(a%mamuan "!an* a5am un&u%

m$ma-ami -a#i+ "&"#i %"m+$%# /3. Ka!$na $!%$m)an*an $#a& (a!i !$#"nan#i

ma*n$&i% /MR ima*in* (an ,"mu&$( &"m"*!a- /CT #$+ama )$)$!aa ($%a($

&$!a%-i!1 5i+aa- !a(i"+"*i &$+a- m$m)$n&an* (a!i "&a%1 (a(a1 (an $!u& $n,i&!aan

%$ jan&un* (an $n,i&!aan +a! m$n*a!&i%u+a#i%an. B$!)$(a ($n*an $#a&na

$!%$m)an*an !a(i"+"*i %+ini#1 $n$!aan m$&"($ $n,i&!aan (a+am !a(i"+"*i

'"!$n#i% &$+a- &$!&in**a+ jau- (i )$+a%an* KASIH $n*$m)an*an &$%ni# (a+am

$!an*%a& $n,i&!aan /2. Uaa un&u% m$n("%um$n&a#i%an &u)u- ($n*an ")$%&i'(an n"nin7a#i' )$!a!&i (imu+ai a(a &a-un 29904an (i In#&i&u& K$("%&$!an "!$n#i%1

Ra(i"+"*i Dia*n"#&i%1 (an N$u!"!a(i"+"* (a!i Uni7$!#i& "' B$!n. Uaa ini

m$n*a%i)a&%an ;


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!a(i"+"*i '"!$n#i% &$+a- m$nin*%a&. Bana% $n$+i&ian &$+a- (i+a%u%an un&u%

m$n*$7a+ua#i u&i+i&a# (a!i #$+u!u- &u)u- "#&m"!&$m MRI (a+am %a#u# n"n4'"!$n#i%

un&u% m$n($&$%#i &$n*%"!a% %"&"!1 (a(a1 $!u& (an $na%i& /=4 9. K$+"m"%4

%$+"m"% +ain &$+a- m$+a%u%an $n,i&!aan "#&m"!&$m #$+u!u- &u)u- ($n*an MDCT

/201 22. Namun1 &i(a% #a&uun (a!i #&u(i ini &$!ma#u% $m$!i%#aan #$+u!u- &u)u-

#i#&$ma&i# m$n**una%an %"m)ina#i &$,&"! mu+&i($4 CT (an MRI /=49 un&u% &ujuan'"!$n#i%. P$n$+i&ian ini (i!an,an* un&u% m$m)an(in*%an &$muan MRI #$+u!u- &u)u-

(i 3.0T (an 24,-ann$+ MDCT un&u% m$n$n&u%an $n$)a) %$ma&ian1 ($n*an

&$muan "&"#i #$)a*ai #&an(a! a,uan.

BAHAN DAN METODE

Su)$%: Lima maa& (ii+i- (i an&a!a %a#u#4%a#u# "&"#i an&a!a $)!ua!i (an Ma!$&

800> S&u(i $n,i&!aan (i+a%u%an #$)a*ai !"#$# !a4$7a+ua#i #$)$+um "&"#i.

P!""#a+ $n$+i&ian &$+a- (i#$&ujui "+$- In#&i&u&i"na+ R$7i$5 B"a!( (an %!i&$!ia in%+u#i

(i$!+u%an maa& &$+a- (a!i in(i7i(u an* )$!u#ia 2> &a-un a&au +$)i- (an an*

(i(u*a m$nin**a+ %a!$na $n$)a) a+ami. K!i&$!ia $%#%+u#i a(a+a- %u!an*na

in'"!m$( ,"n#$n& (a!i %$+ua!*a1 ,$($!a $%#&!im1 a&au $m)u#u%an &u)u-. Su)$%

$n$+i&ian &$!ma#u% $ma& !ia (an #a&u 5ani&a. U#ia m$!$%a )$!%i#a! 834?2 &a-un

/!a&a4!a&a1 =?1> &a-un. CT (an MRI (i+a%u%an (a+am 5a%&u 48= jam #$&$+a-

%$ma&ian. Maa&4maa& an* (i)un*%u# ($n*an %ain 7in+ 5!a$! un&u%

m$n,$*a- %"n&amina#i (a!i m$#in %a!$na a(a #$%!$#i a&au $!(a!a-an (a!i &u)u-.

CT S,annin* CT (i+a%u%an a(a 24($&$%&"! MDCT /S$n#a&i"n 2@ Si$m$n#1

E!+an*$n1 $!man. Su)$% (i,i&!a%an (a+am "#i#i &$!+$n&an* ($n*an &an*an nai%

(a!i &i&i% #amai %a%i (a+am (ua a%ui#i#i #i!a+. S$mua *am)a! an* (i$!"+$-

($n*an m$n**una%an 2.4mm ($&$%&"! ($n*an uman &a)$+ 3 mm $! !"&a#i/i&,- 2.. P!"&"%"+ un&u% #$mua a%ui#i#i $min(aian m$+i)a&%an $n**unaan

+aan*an -$+i%# (a!i 0138: 21 280 %


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&$!+$n&an*1 ($n*an &an*an (i #amin* &u)u- (an (i$!i%#a (a!i %$a+a #amai %a%i.

Gam)a! %"!"na+ (an #a*i&a+ (i$!"+$- ($n*an m$n**una%an O< ma%#imum =40

,m (an in7$!#i $mu+i-an &u!)" &au $n($% /S"#"+ m$+a+ui +ima #&a#iun (i

"!i$n&a#i %"!"na+: %$a+a +$-$!1 (a(a $!u&1 an**u+1 a-a1 (an )$&i#.

S$+anju&na1 #$+u!u- &u)u- (i4#,an ($n*an %"!"na+ (an #a*i&a+ T24&$!&im)an* ,$a&

manja /SPGR u!u&an *!a(i$n&4$,-". P$n,i&!aan S"#"+ #$+u!u- &u)u- mun*%in(a+am 2848> m$ni& (an T24&$!&im)an* $n,i&!aan (a+am 2042 m$ni& a(a 213

212 mm (an 21> 2.3 mm R$#"+u#i $#a5a& (i4ma#in*4ma#in*. T"&a+ 5a%&u

$n,i&!aan un&u% $n,i&!aan #$+u!u- &u)u- %u!an* (a!i =0 m$ni& (a+am #$mua

%a#u#. i%a &$muan u&ama an* &$!($&$%#i a(a *am)a! #$+u!u- &u)u- a&au +u%a

$%#&$!na+ (i&$mu%an a(a )a*ian &u)u-1 in7$#&i*a#i +$)i- ($%a& (i+a%u%an ($n*an

)$!($(i%a#i %uma!an +"%a+ /%$a+a ,"i+1 ,"i+ $!mu%aan1 ,"i+ )a-u /Ta)$+ 8.

S$&$+a- $m$!i%#aan1 *am)a! #$,a!a $+$%&!"ni% #$+a!a# ($n*an #a+a- #a&u ,i&!a

#$+u!u- &u)u- a(a )i(an* %"!"na+ (an #a*i&a+ m$n**una%an $!an*%a& +una%

%"m$!#ia+.

Gam)a! In&$!!$&a#i

A4)"a!( )$!#$!&i6%a& a-+i !a(i"+"*i ($n*an $nam &a-un $n*a+aman (a+am

m$m)a,a *am)a! mu#%u+"#%$+$&a+ !"#$%&i' &$!a%-i! CT #$+u!u- &u)u- (an MR

*am)a!1 an* %$mu(ian (i#$)u& ,a!(i"!a(i"+"*i#& #$)ua-1 a-+i !a(i"+"*i (a(a1 "*i#

!a(i"+4 $!u&1 n$u!"!a(i"+"*i#&1 (an %$a+a (an +$-$! a-+i !a(i"+"*i1 (an m$+anju&%an

un&u% m$n*ana+i#i# (a&a !a(i"+"*i ($n*an '"%u# a(a #u)#$#ia+i#a#i m$!$%a.

M$!$%a ma#in*4ma#in* m$+a%u%an $7a+ua#i m$!$%a (i)u&a%an ($n*an &$muan

"&"#i (an ("%um$n&a#i '"&"*!a6. Namun1 in&i a&"+"*i '"!$n#i% )$!a!&i#ia#i (a+am

CT (an MR a%ui#i#i ,i&!a (an m$n**am)a!%an i($n&i&a# ma#in*4ma#in* maa& (an

a($*an %$,$+a%aan un&u% a-+i !a(i"+"*i. A5a+na1 #$&ia a-+i !a(i"+"*i #$,a!a

in($$n($n #$+$#ai !in,i +$m)a! (a&a $n,i&!aan ($n*an ,a&a&an an* &$!)ua& (a!i

&$muan !a(i"+"*i#. T$muan !a(i"+"*i %$mu(ian (i%+a#i6%a#i%an #$)a*ai u&ama1

+an*#un* )$!-u)un*an ($n*an $n$)a) %$ma&ian1 a&au %$,i+1 &$muan in#i($n&a+

/201 28. T$muan u&ama an* (i#$(ia%an (a+am +a"!an !in*%a#an "&"#i #$)a*ai

(a#a! an* !$+$7an un&u% $n$)a) %$ma&ian (i)an(in*%an ($n*an -a#i+ $7a+ua#i

!a(i"+"*i. P!"#$# $7a+ua#i !a(i"+"*i1 an* m$+i)a&%an m$n$n&u%an aa%a- &$muan

!a(i"+"*i -a!u# (ima#u%%an (a+am $n$)a) %$ma&ian (an (i%+a#i6%a#i%an #$)a*ai

)$#a! a&au %$,i+1 (iu&u#%an "+$- a-+i !a(i"+"*i #$&$+a- %"n#u+&a#i ($n*an ma#in*4

ma#in* #u)#$,ia+i#&. CT (an MRI &$muan (i)an(in*%an ($n*an &$muan

(i("%um$n&a#i%an (a+am !"&"%"+ "&"#i (an (i*una%an #$)a*ai #&an(a! !$'$!$n#i.

O&"#i

Au&"#i (i+a%u%an1 (a+am 5a%&u 8 jam #$&$+a- $n,i&!aan "+$- a-+i a&"+"*i

)$!#$!&i6%a& ($n*an #$&i(a%na 20 &a-un $n*a+aman (a+am a&"+"*i '"!$n#i%1

#$#uai ($n*an !"&"%"+ #&an(a!. A-+i a&"+"*i an* m$+a%u%an "&"#i (i)u&a%an

($n*an CT (an MRI &$muan. Ru&in &i"n (i##$,4 '"!ma+ &$n*%"!a%1 (a(a1 (an $!u&1

&$!ma#u% u#u# (an j$!"an1 (i+a%u%an (a+am +ima maa&. K$&i%a !"#$(u! "&"#i


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(i+a%u%an1 #$jau- mana (i#$%#i (iu&u#%an "+$- a-+i a&"+"*i '"!$n#i%. $n$)a)

%$ma&ian1 $na%i& !im$!1 $na%i& an* &$!%ai&1 (an &$muan in#i($n&a+ %$mu(ian

(i!$%am. T$muan (i CT (an MRI %$mu(ian )$!%"!$+a#i ($n*an &$muan "&"#i.

HASIL

T$muan ma"! (an min"! (i!an*%um (a+am Ta)$+ 3 (an =1 ma#in*4ma#in*.

P$n$)a) %$ma&ian )$!(a#a!%an CT (an MRI &$muan #$&uju ($n*an m$!$%a

)$!(a#a!%an &$muan "&"#i (i $ma& (a!i +ima %a#u# /Ta)$+ . Da+am %a#u# +ain1

$na%i& jan&un* i#%$mi% /IHD (i(u*a #$)a*ai $n$)a) "&$n#ia+ %$ma&ian

)$!(a#a!%an ,i&!a MR.

K$a+a (an L$-$!

L$#i in&!a%!ania+ &$!($&$%#i (a+am &i*a %a#u#. Da+am %a#u# %$&i*a1 CT #,an

m$n*un*%a%an )a-5a a#i$n &$+a- m$n*a+ami ,!ani"+a#& a(a &u+an* &$m"!a+.

MRI #,an m$n*un*%a%an &a-a a%-i! $!(a!a-an #u)a!a,-n"i( a(a $!mu%aan

+")u# &$m"!a+. Da+am %a#u# %$$ma&1 CT #,an m$nunju%%an a&a- &u+an*

&$m"!a+1 '!a%&u! (a$!a- %a%u1 (an m$n$)a! $!(a!a-an #u)a!a,-n"i(1 &$&ai MRI

*a*a+ m$n($&$%#i '!a%&u! &u+an* &$m"!a+ /Gam)a!. 3. Da+am %a#u# %$+ima1

$!(a!a-an in&!a#$!$)!a+ (i&unju%%an (i MRI (an CT #,an1 &$&ai -ana CT #,an

m$n*un*%a%an &in*%a& #$)$na!na (a!i '!a%&u!1 an* (i$!+ua# %$ "%#ii&a+1

a!i$&a+1 (an &u+an* '!"n&a+.

T-"!aF

Da+am #a&u %a#u# /%a#u# 31 $!*$#$!an m$(ia#&inum (iama&i %$ #i#i %i!i1 an*

(i#$)a)%an "+$- n$um"&"!a%#1 ($n*an )$)$!aa a&a- &u+an* !u#u% a(a CT (an

MRI #,an /G)!. 2A4D. CT #,an m$nunju%%an $m6#$ma #u)%u&an #$anjan* )a*ian

+ua! (in(in* (a(a %anan /G)!. 2B1 C.

an&un* (an P$m)u+u- )$#a!

Da+am #a&u %a#u# /%a#u# 21 (i mana $n$)a) %$ma&ian &$+a- (i%"n6!ma#i un&u%

IHD ($n*an $!u)a-an a&$!"#%+$!"#i# )$!a& (an -i$!&!"6 (in(in* 7$n&!i%$+ %i!i1 MRI

m$nunju%%an -i$!&!"6 (in(in* 7$n&!i%$+ %i!i a(a *am)a! T84&$!&im)an*. Ka!$na

&i(a% a(a &$muan &am)a-an (i(u%un* IHD1 %ami m$n*%+a#i6%a#i%an IHD -ana

#$)a*ai $n$)a) "&$n#ia+ %$ma&ian (a+am %a#u# ini. CT *am)a! m$nunju%%an

%a+#i6%a#i %"!"n$! (a+am (ua %a#u# /%a#u# 21 . Da+am #a&u %a#u# /%a#u# 81 CT (an

MR *am)a! m$nunju%%an ")+i&$!a#i %aa+ (i a-a (an (a$!a- in*uina+ (an a!&$'a%+"*am +$n*%un* /Gam)a!. 8A1 !un&u-na a"!&a $!u& (an 7$na ,a7a in'$!i"!

/Gam)a!. 8B 1 (an &i(a% a(ana %$a(a&an m$nin*%a& a(a a!$n%im a!u

/Gam)a! 8C.1 m$nunju%%an $!(a!a-an ma#i' a%i)a& ,$($!a 7a#%u+a! $m)u+u-

'$m"!a+i#@ -a+ ini (i$!%ua& "+$- &$muan "&"#i /G)!. 8D1 E.

A)("m$n


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Da+am %a#u# %$&i*a1 )ai% CT (an MRI m$nunju%%an +a#$!a#i -a&i a(a +")u# %anan

-a&i ($n*an $!(a!a-an in&!a$!i&"n$a+1 an* %"n#i#&$n ($n*an &$muan "&"#i /G)!.

2E1 .

Sin$ (an E%#&!$mi&a#

CT m$+$5a&%an #a&u '!a%&u! /T> (an MRI m$n($&$%#i #$mua $nam a&a- &u+an*

)$+a%an* /C341 T?1 T>1 (an L2 (i%"n6!ma#i "+$- "&"#i (a+am %a#u# 3 /G)!. 2A.

S$)a+i%na1 *am)a! S"#"+ m$n*un*%a%an #ina+ &in**i +$#i in&$n#i&a# (a+am

&u)u- 7$!&$)!a+ (a(a %$(ua (an %$&i*a1 m$nunju%%an m$ma! &u+an* )$+a%an*

(i+i-a& #$)a*ai 5i+aa- *$"*!a6# n"n+in$a!1 $nin*%a&an in&$n#i&a# #ina+ a(a

#um#um &u+an*1 an* &i(a% (i&$mu%an "+$- "&"#i. Da+am maa& an* #ama1 CT (an

MR *am)a! m$nunju%%an )a-5a %$a+a '$m"!a+ (i#+"%a#i "#&$!i"! (a!i a,$&a)u+um

(a!i &u+an* an**u+ /Gam)a!. 2. MRI m$n($&$%#i &uju- (a!i 28 ,$($!a ja!in*an

+una% (i%"n6!ma#i "+$- "&"#i /> /Gam)a!. =.

PEMBAHASAN

S$m$n&a!a "&"#i &!a(i#i"na+ (ian**a #$)a*ai #&an(a! $ma# un&u% $n$+i(i%an

"#&m"!&$m1 ia m$mi+i%i )$)$!aa %$&$!)a&a#an an* j$+a#. P$!&ama1 #u)j$%&i' (an

&$!*an&un* "$!a&"! /3. K$(ua1 (a+am %a#u#4%a#u# %$&i%a #$)ua- $&unju% $n&in*

(a+am %$ja-a&an an* )a!u (i&$mu%an1 in&$!!$&a#i )a!u (a!i ,$($!a maa&

)$!(a#a!%an $&unju% an* mun*%in (i$!+u%an. Namun1 #$$!&i &in(a% +anju&

!$7i$5 (a!i maa& -a!u# )$!*an&un* a(a ("%um$n &$!&u+i# (an )a*ian an* (ii+i-

a&au #$#im$n %$,i+ (i&a-an un&u% $m$!i%#aan -i#&"+"*i# %a!$na #i#a ja!in*an

&u)u- mun*%in &$+a- (i)uan* /3. K$&i*a1 ($n*an &i(a% a(ana in'"!ma#i ,an**i-1

"&"#i )i#a %$-i+an*an ,$($!a &!auma&i# (a!i $%#&!$mi&a# &ana +u%a +ua! (an +$#i

an* #u+i& (ia%#$# "+$- (i#$%#i )$(a-1 #$$!&i ,$($!a !"n**a &$+in*a &$n*a-.A%-i!na1 m$ma-ami ("%um$n&a#i &$muan "&"#i #$!in*%a+i #u+i& )a*i "!an* a5am.

S$+ama ($%a($ &$!a%-i!1 !a(i"+"*i '"!$n#i% &$+a- m$nan&an* "&"#i %"n7$n#i"na+

#$)a*ai a+a& un&u% &ujuan1 &i"n ("%um$n&a#i &a% !u#a% &$muan '"!$n#i% an*

!$+$7an. S$ja% +a"!an $!&ama "+$- Wu++$n5$)$! $& a+. /23 a(a &a-un 29??

&$n&an* CT $n,i&!aan +u%a &$m)a% &$n*%"!a%1 m$&"($ !a(i"+"*i %+ini# &$+a-

(i+a%u%an un&u% &ujuan '"!$n#i%. M$#%iun #ina!4 %"n7$n#i"na+ &$+a- #$!in*

(i*una%an (a+am !a%&$% #$-a!i4-a!i '"!$n#i%1 a+i%a#i !a%&i# (a!i1 m$&"($ )a!u

%+ini# maan #$$!&i CT (an MRI &ama%na &$+a- ja&u- (i )$+a%an* (a+am '"!$n#i%

/2. T-$ ;01 -a#i+ %ami m$nunju%%an

%"n#i#&$n#i an* )ai% an&a!a &$muan !a(i"+"*i (an "&"#i (a+am m$n$n&u%an


6/10

$n$)a) %$ma&ian1 an* m$!ua%an &in*%a& a%u!a#i an* +$)i- &in**i (a!ia(a

(a+am +a"!an #$)$+umna. CT (an MRI m$mi+i%i &in*%a& an* #ama a%u!a#i (a+am

m$n$n&u%an $n$)a) %$ma&ian. S$,a!a !in,i1 CT $n,i&!aan )i#a m$m)$!i%an

(ia*n"#i# an* (aa& (ian(a+%an un&u% ,$($!a %$a+a &!auma&i#1 #$(an*%an &$muan

MRI m$na!an%an %$mun*%inan $na%i& jan&un* i#%$mi%.

W-"+$4B"( CT

P$n,i&!aan CT #an*a& )$!-a!*a un&u% m$n($&$%#i &$muan &u+an*1 )$n(a a#in*1

$m)"+i#m# u(a!a1 (an %$+ainan )!u&" a(a ja!in*an +una% /22. Da&a i#"&!"i% (aa&

(i$!"+$- ($n*an &$%n"+"*i MDCT jau-4,an**i-1 an* m$mun*%in%an un&u% !$#"+u#i

&in**i !$%"n#&!u%#i +ana! mu+&i /2=1 2. MDCT (aa& (i*una%an un&u% $!&ama %a+i

m$+a%u%an ,$a&1 +aa! $nu-4&u)u- un&u% m$n$n&u%an )i(an* mina& '"!$n#i%

&$!&$n&u. K$mu(ian1 (a&a ima*in* an* (i$!"+$- (a!i CT #,an #$+u!u- &u)u- (aa&

(i!$%"n#&!u%#i %$ #$*a+a a!a-1 m$mun*%in%an un&u% $ma-aman +$n*%a &$n&an*

%a!a%&$!i#&i% '!a%&u! (i%$m)an*%an (a!i $%#&$!na+ ,$($!a. S$)ua- O< an* +$)i-

)$#a! (an 5a%&u a%ui#i#i +$)i- ,$a& ($n*an !$#"+u#i &in**i (aa& (i,aai ($n*anm$n**una%an 24($&$%&"! #,ann$!. M$man*1 #aa& CT #,an (a!i %$a+a #amai +u&u&

a(a+a- %u!an* (a!i 3 m$ni&. Da+am $n$+i&ian %ami1 CT (i&$mu%an m$nja(i un**u+

MRI (a+am m$n($&$%#i a&a- &u+an* &$n*%"!a%1 an* %"n#i#&$n ($n*an +a"!an

#$)$+umna /3. Mu+&i($&$,&"! $n,i&!aan CT m$mi+i%i )$)$!aa %$un**u+an

(i)an(in*%an MRI (a+am m$n($&$%#i ,$($!a &u+an*1 &$!ma#u% a&a- &u+an* (an

(i#+"%a#i /21 #$!&a (a+am m$ni+ai n$um"&"!a%# (an $!(a!a-an 'a&a+. M$n($&$%#i

a&a- &u+an* %$,i+ )$)$!aa &u+an* #an*a& (u(u% (a+am &u)u-1 #$$!&i &u+an*

)$+a%an*1 #u+i& /2: Ha#i+ $n$+i&ian %ami m$nunju%%an )a-5a MDCT $n,i&!aan

(aa& m$n($&$%#i )$)$!aa '!a%&u! *ai) (i &$n*%"!a%1 &u+an* )$+a%an*1 (an %a%i

($n*an !$%"n#&!u%#i +ana! mu+&i. S$+ain i&u1 $n,i&!aan i#"&!"i% m$n**una%an

a+*"!i&ma !$%"n#&!u%#i 34D1 #$$!&i &$%ni% 7"+um$ !$n($!in*1 (aa& (i*una%an un&u%

m$nami+%an a&a- &u+an* %"m+$%# (an (i#+"%a#i /=. Da+am m$n*ana+i#i#

$n$)a) a&a- &u+an* &$n*%"!a%1 m$n$n&u%an aa%a- '!a%&u! a(a+a- -a#i+ (a!i

ja&u- %$ &ana- a&au u%u+an %$ %$a+a a(a+a- ma#a+a- '"!$n#i% $n&in* %$&i%a

#$#$"!an* m$nin**a+ a5a+na (i&$mu%an &$!*$+$&a% &$!+u%a (i &ana-. P$n$n&uan ini

(aa& (i+a%u%an a&a# (a#a! #i#&$m %-a# a&a- &u+an* &$n*%"!a%1 ,i!i4,i!i m"!'"+"*i

+u%a ,!u#-1 (an +$#i ,"n&!$4%u($&a (a+am "&a% /=. 34D 7"+um$ (i)$!i%an CT

$n,i&!aan (a+am %a#u# %$$ma& m$nunju%%an %$#an +"%a+ an* %-a# (a+am &u+an*

&$m"!a+ &$n*%"!a%1 m$nunju%%an '!a%&u! i&u (i#$)a)%an "+$- u%u+an (a!i a+u.

S$$!&i (i&unju%%an (a+am Gam)a! 21 i($n&i6%a#i (i#+"%a#i "#&$!i"! -i

(i$!)"+$-%an un&u% $n$n&uan a%u!a& (a!i a!a- (ama%1 m$nunju%%an %$un&un*an(a!i 7i!&ua+ m$+a+ui &$%ni% "&"#i %"n7$n#i"na+. K$&$*an*an n$um"&"!a%# #u+i&

(i($&$%#i "+$- "&"#i %a!$na a&"+"* mun*%in a%an m$+$5a&%an $!*$#$!an na+

m$(ia#&i4 a(a #aa& !"n**a (a(a (i)u%a /21 2. Da+am $n$+i&ian %ami1 *am)a! CT

(a!i %a#u# 3 m$nunju%%an !un&u-na a!$n%im a!u1 ($n*an m$(ia#&inum #-i'& (an

&u+an* !u#u% a&a- m$n$m)u# (in(in* (a(a. CT #,an ju*a m$nunju%%an $m6#$ma

ja!in*an +una% an* +ua# (i #$anjan* (in(in* (a(a1 m$nunju%%an )a-5a 7$n&i+a#i


7/10

)$!+an*#un* #$+ama )$)$!aa 5a%&u #$&$+a- %$,$+a%aan /=. Samai #aa& ini1

#$(i%i& an* (i%$&a-ui &$n&an* &$muan !a(i"+"*i %$ma&ian "+$- $!(a!a-an 'a&a+.

D$n*an &i(a% a(ana $!(a!a-an $%#&$!na+ ma#i'1 #$jum+a- )$#a! (a!a- )ai% (a+am

(a(a a&au !"n**a $!u& (aa& ($n*an mu(a- (i($&$%#i ($n*an $n,i&!aan /2.

Da+am %a#u#4%a#u# $!(a!a-an )$#a!4)$#a!an1 u,a& in&$n# "!*an m$!ua%an

&$muan %a!a%&$!i#&i% an* m$n*i#a!a&%an $!(a!a-an an* +ua# &$!($&$%#i -ana#$&$+a- $m$!i%#aan a&"+"*i#@ T$muan ini &i(a% (aa& (i($&$%#i "+$- CT a&au MR

*am)a! /2. S$$!&i (i&unju%%an (a+am Gam)a! 81 (an #$$!&i an* (i#a!an%an

"+$- T-a+i $& a+. /21 ji%a $!(a!a-an ma#i' &$!ja(i1 !un&u-na a"!&a m$nu!un

mun*%in m$!ua%an &an(a !a(i"+"*i# (i!$!"(u%#i $!(a!a-an ma#i' a&au )a-%an

'a&a+. S$+ain i&u1 $($ma a!u (i%$na+ #$)a*ai $!u)a-an "#&m"!&$m &$!%ai& /2?.

Dua m$%ani#m$ an* (iu#u+%an un&u% $($ma a!u "#&m"!&$m a(a+a- *!a(i$n

&$%anan an&a!a $m)u+u- (a!a- a!u (an !uan* a+7$"+a! (an $!u)a-an

$!m$a)i+i&a# %ai+$! /2?. Kami $!,aa )a-5a #$+ain !un&u-na a"!&a m$nu!un1

a(ana $($ma a!u (aa& &an(a +ain an* m$n(u%un* $!(a!a-an 'a&a+ a(a CT

ima*in*1 an* (i&ami+%an #$)a*ai (i'u# m$nin*%a& "a,i& (i a!$n%im a!u

($n*an $n*a&u!an j$n($+a a!u4a!u.

W-"+$4B"( MRI

MRI #$+u!u- &u)u- m$nja(i #$ma%in umum (i )i(an* $n,i&!aan "n%"+"*i #$)a*ai

&am)a-an a&au a+&$!na&i' un&u% $n($%a&an mu+&im"(a+ (i(i!i%an /mi#a+na1

!a(i"*!a61 MDCT1 USG1 #%in&i*!a6 (a+am &um"! a5a+ $m$n&a#an a&au #%!inin*

un&u% &$!ja(ina %$m)a+i &um"! #$&$+a- &$!ai %u!a&i' /2>. S$+anju&na1 (a+am MRI

#$+u!u- &u)u-1 %$un&un*an (a+am !a#i" #i*na+4&"4n"i#$ (aa& (i*una%an un&u%

m$n*u!an*i 5a%&u $min(aian #$,a!a %$#$+u!u-an1 &$!u&ama un&u% a%ui#i#i T81

u!u&an +$ma% (i&$%an a(a !$#"+u#i *am)a! %"n#&an m$n**una%an 3.0T MRI /29.

U!u&an u+#a u&ama an* (i*una%an (a+am $n$+i&ian %ami a(a+a- SPGR (an &u!)"

S"#"+ $n,i&!aan1 an* &$+a- &$!)u%&i $'$%&i' un&u% m$n*$7a+ua#i ja!in*an (an

&u+an* #&!u%&u! +una% /2. S$)ua- %$#$njan*an an* )$#a! an&a!a )a*ian

)$!($%a&an (an ,a%uan &$!)a&a# &u)u- &$+a- m$nja(i %$n(a+a u&ama un&u%

$n$+i(i%an ($%a& &u)u- (a+am $n,i&!aan. Da+am $n$+i&ian %ami1 %ami

m$nunju%%an %$un**u+an &$%ni# (a!i MRI #$+u!u- &u)u- (i 3.0T1 +$)i- (a!i #&u(i

$n(a-u+uan1 &$!ma#u% $nin*%a&an !a#i" %$#$+u!u-an #i*na+4&"4n"i#$1 a(a

%$#$njan*an an&a!a )a*ian1 (an ,a%uan $nu- &u)u- (a!i %$a+a #amai %a%i.

S,an MRI 5a%&u un&u% #$+u!u- &u)u- (a+am $n$+i&ian %ami a(a+a- %u!an* (a!i =0

m$ni&1 (an (iiJin%an !$#"+u#i $n,i&!aan )$!%ua+i&a# &in**i. K$,ua+i un&u% "!*an

&$!&$n&u1 #$$!&i "&a% (an jan&un*1 an* MRI ($n*an #i#&$m mu+&i4,"i+ mu+&i,-ann$+(i$!+u%an un&u% #$$nu-na m$man'aa&%an "&$n#i 3.0T1 3.0T an* #$+u!u- &u)u-

MRI m$m)$!i%an &in**i *am)a! !$#"+u#i #a#ia+ un&u% $na!in*an #$+u!u- &u)u- (i

a&"+"*i '"!$n#i%1 &$!ma#u% (a$!a- an* &i(a% (i)u%a (i !"#$(u! "&"#i !u&in.

Da+am 5a%&u ($%a&1 5a%&u $min(aian un&u% #$+u!u- &u)u- (aa&

m$m$!&im)an*%an $n**unaan ,a%a (i%u!an*i ($n*an $n,i&!aan a!a+$+1 an*

(aa& m$n$)a)%an m$+ua#na $n**unaan MRI #$+u!u- &u)u- (a+am $n$+i(i%an


8/10

'"!$n#i%. Y$n $& a+. /3 m$+a"!%an )a-5a MRI (an CT m$mi+i%i "&$n#i un&u%

m$main%an $!an $n&in* (a+am $m$!i%#aan n$u!"a&-"+"*i,a+ '"!$n#i% (i ma#a

($an. M$man*1 -a#i+ %ami m$nunju%%an1 (a+am (ua %a#u# /%a#u# =1 1 )a-5a MRI

(an CT $n,i&!aan #ama4#ama $'$%&i' (a+am m$n*$7a+ua#i $!(a!a-an in&!a%!ania+1

&$!ma#u% in&!a#$!$)!a+1 #u)a!a,-n"i(1 $!(a!a-an in&!a7$n&!i%u+a! (an /3. S$,a!a

%-u#u#1 #$$!&i an* (i&unju%%an (a+am %a#u# 31 MRI m$n*un*%a%an $!(a!a-an&ua (i +")u# &$m"!a+ an* &$a&1 an* &i(a% &$!+i-a& "+$- CT $n,i&!aan. G!a(i$n&4

*$ma MRI mun*%in +$)i- $'$%&i' (a+am m$n$mu%an j$ja% $!(a!a-an +ama (a!ia(a

#in4$,-" $n,i&!aan %"n7$n#i"na+ /80. Pa&"+"*i ja!in*an +$ma% #u)%u&an1 an*

!$n&an &$!-a(a &!auma &umu+1 (aa& (i+i-a& ($n*an j$+a# (i MRI. MRI ju*a &$!a&u!

(i*una%an (a+am $ni+aian %"!)an an* #$+ama& &!auma &umu+1 &$!u&ama (a+am

%a#u#4%a#u# $n,$%i%an /82. MRI #$+u!u- &u)u- m$m)an&u m$n($&$%#i +$#i "&"&

(an ja!in*an +una% (a+am %a#u# 21 31 (an 1 an* (aa& )$!*una (a+am m$n$n&u%an

%$%ua&an (ama% /88 (an ju*a1 a!a- (a+am )$)$!aa %a#u#. M$n($&$%#i +$#i

&!auma&i# (a+am ja!in*an +$ma% #u)%u&an )$!*una1 %a!$na m$!$%a (aa&

m$m)$!i%an $&unju% $n&in* (a+am $n$+i(i%an '"!$n#i%. Ra(i"+"*i '"!$n#i%1

)$!(a#a!%an CT ,an**i- (an MRI1 (aa& (i+a%u%an n"nin7a#i' (an ")$%&i'. Y$n $& a+.

/88 m$+a"!%an )a-5a MRI (aa& m$n$n&u%an +$#i #u)%u&an /$!(a!a-an

$!i+")u+a! !in*an. Da+am %$,$+a%aan %$n(a!aan )$!m"&"!1 m$&"($ !a(i"+"*i &$+a-

(i*una%an un&u% m$n*i($n&i6%a#i +"%a#i (ama% (an a!a- (a+am %"!)an. Da+am

#a&u #u)j$% /%a#u# 31 "+a $n*-an,u!an )$#a!4)$#a!an ja!in*an +$ma% (an !"n**a

#u)%u&an )$#a!1 (i mana (a!a- (an +$ma% ,ai! &$+a- (i%umu+%an1 m$nunju%%an

)a-5a %"!)an &$+a- (i&a)!a% m")i+1 #$)a*ai j$ni# &!auma #$!in* m$n$!&ai (i#am)a!

!"(a )$!u&a! /=. Da+am !a%&$% %+ini#1 MRI m$mi+i%i a!&$'a% %$!$n&anan an*

(i+i-a& #$)a*ai 7"i( #ina+ (an (i#&"!#i ($n*an a(ana +"*am (i (a$!a- ana&"mi

)un*a /83. S$)a+i%na1 MRI m$n**una%an a!&$'a% %$!$n&anan &$+a- (i*una%an

un&u% m$n($&$%#i $!(a!a-an in&!a%!ania+ /8=. S$$!&i an* &$!+i-a& (a+am %a#u#%ami 81 a!&$'a% +"*am a(a *am)a! MR &$!+i-a& (a!i (a$!a- in*uina+ %$ a!&$!i i+ia%a

%"muni# %anan1 m$nunju%%an )a-5a )$n(a +"*am m$n$m)u# a-a #$anjan*

+in&a#an i&u. D$n*an ($mi%ian1 %ami $!,aa )a-5a a!&$'a% +"*am (i MRI (aa&

#$,a!a $'$%&i' (i*una%an un&u% m$ni+ai a!a- (a!i mana +u%a m$nu#u% (i,i&a%an

"+$- )$n(a +"*am (a+am i+mu '"!$n#i%. K$(ua MDCT (an MRI &$!#$(ia *am)a! an*

)ai% ,$($!a &u)u- 7$!&$)!a+ (a+am $n$+i&ian %ami. Namun1 CT #,an m$+$5a&%an

#a&u a&a- &u+an* )$+a%an*. Kami )$!#$%u+a#i )a-5a a+a#an u&ama un&u% n$*a&i'

a+#u CT m$m)a,a a(a+a- )a-5a %ami m$n**una%an %$&$)a+an (i!$%"n#&!u%#i (a!i

3 mm. M$n**una%an %$&$)a+an (i!$%"n#&!u%#i &ii# (aa& m$n$)a)%an (ia*n"#i#

an* +$)i- a%u!a& (a!i a&a- &u+an* )$+a%an* #$)an(in* ($n*an MRI #,an.M$n$mu%an m$ma! &u+an* &u+an* )$+a%an* (a+am "&"#i %"n7$n#i"na+ &ama%na

#u+i& %a!$na &u+an* )$+a%an* )ia#ana &i(a% &$!ma#u% (a+am !"&"%"+ !u&in "&"#i

'"!$n#i%1 (an m$ma! &u+an* mun*%in )u%an %$+ainan m"!'"+"*i +"*i# u&ama. Da+am

%a#u# 31 $n,i&!aan S"#"+ m$mun*%in%an (ia*n"#i# (ua %"n&u#i" 7$!&$)!a+ &i(a%

(aa& (ia%#$# "+$- m"(a+i&a# $n,i&!aan +ain (an $7a+ua#i '"!$n#i% n"!ma+. D$n*an

($mi%ian1 %ami $!,aa )a-5a MRI m$!ua%an #a!ana )$!-a!*a un&u%

m$n**am)a!%an m$ma! &u+an*1 an* (aa& m$nja(i &$muan '"!$n#i% u&ama


9/10

m$n*un*%a%an a!a- (ama% /8. Da+am $n$+i&ian %ami1 CT (an MRI *a*a+

m$n($&$%#i in'a!% mi"%a!( (a+am #a&u %a#u# /%a#u# 2. M$#%iun $n$)a)

%$ma&ian (a+am %a#u# an* (i&$n&u%an )$!(a#a!%an #&$n"#i# )$!a& a!&$!i %"!"n$!

(an -i$!&!"6 7$n&!i%$+1 &i(a% a(a )u%&i +an*#un* in'a!% mi"%a!( (i&$mu%an1 )a-%an

a(a "&"#i. Ti(a% a(ana a&"+"*i mi"%a!( a(a+a- %a!$na i#%$mi% -i$!a%u&1 an*

(i%$na+ un&u% maju &$!+a+u ,$a& un&u% m$mun*%in%an $!u)a-an #$+u+$! (i%$na+i(an !$a%#i ja!in*an 7i&a+1 &$!ma#u% $($ma (an n$%!"#i# a(a mi"%a!(ium

#$%i&a!na. D$n*an ($mi%ian1 )ai% #&u(i $n,i&!aan a&au "&"#i1 m$n*i($n&i6%a#i

a&"+"*i mi"%a!(ium /8. M$nu!u& G!a)-$!! $& a+. /8?1 #$&$+a- $m$!in&a-

#i+7i%u+&u! $!'u#i "#&m"!&$m ($n*an mina% a!a6n (an inj$%#i a*$n %"n&!a#

)$!mina%1 #i#&$m $m)u+u- (a!a- (aa& (i#$+i(i%i #$,a!a !in,i (an %$+ainan

$m)u+u- (a!a- (i)$!i%an &$!+i-a&. M$&"($ ini mun*%in )$!*una un&u%

m$nin*%a&%an ($&$%#i $na%i& jan&un* i#%$mi%. Kami m$!$%"m$n(a#i%an

$n**unaan #imu+&an (a!i CT (an MRI (a+am "#&m"!&$m $n,i&!aan #$+u!u- &u)u-

%a!$na %$(ua m"(a+i&a# $n,i&!aan (aa& #a+in* m$+$n*%ai #$,a!a $'$%&i'. Namun1

)$)$!aa %$&$!)a&a#an an* a(a (a+am $n**unaan '"!$n#i% (a!i CT #,an )$!#ama

($n*an #,an MRI1 &$!ma#u% )iaa &in**i (an !$n(a-na %$&$!#$(iaan m"(a+i&a#

$n,i&!aan. Un&u% a+a#an ini1 $n**unaan &$%ni% $n,i&!aan #$+u!u- &u)u-

(i$!+u%an un&u% m$mun*%in%an $mu&a!an +$#i '"!$n#i% (a+am %$!an*%a 5a%&u

(i&"+$!an#i. M$nin*%a&na jum+a- +$m)a*a an* (i)$n&u% $m$!in&a- an*

(i+$n*%ai ($n*an CT (an MRI #,ann$! a%an m$nu!un%an )iaa (a+am 5a%&u ($%a&.

P$n$+i&ian %ami m$mi+i%i )$)$!aa %$&$!)a&a#an. P$!&ama1 m$n*in*a& jum+a- %$,i+

%a#u#1 &$muan #&u(i ini -a!u# (ian**a #$)a*ai -a#i+ a5a+. P$%$!jaan +$)i- +anju&

($n*an u%u!an #am$+ an* +$)i- )$#a! (i$!+u%an un&u% m$m7a+i(a#i &$muan

%ami. K$(ua1 #$jum+a- )ia# #u)j$%&i' mun*%in &$!ja(i %a!$na #a+a- #a&u a-+i !a(i"+"*i

-a!u# m$n$n&u%an $n$)a) %$ma&ian ($n*an ma#in*4ma#in* m"(a+i&a#

$n,i&!aan1 #$&$+a- m$n(aa& #a!an (a!i &uju- a-+i !a(i"+"*i #u)#$#ia+i#a#i +ainun&u% m$m)an&u (a+am m$na'#i!%an CT (an MRI &$muan. K$&i*a1 !$#"+u#i #a#ia+ (i4

$#a5a& (a!i #$+u!u- &u)u- *am)a! MR (a+am $n$+i&ian %ami &i(a% un**u+ !$#"+u#i

&$!#$)u& (a+am $n$+i&ian #$)$+umna (i mana #$+u!u- $n,i&!aan MR &u)u-

(i*una%an un&u% %+ini# $7a+ua#i@ 5a%&u an* &$!#$(ia un&u% $n,i&!aan MR

"#&m"!&$m (i)a&a#i (a+am +$m)a*a %+ini# %ami. S$)ua- MRI %-u#u# un&u%

$n,i&!aan '"!$n#i% (aa& m$nin*%a&%an !$#"+u#i *am)a!. A%-i!na1 a(a

%$mun*%inan #a+a- m$na'#i!%an &$muan '"!$n#i% %a!$na #$)a*ian )$#a! a-+i

!a(i"+"*i an* )$!a!&i#ia#i (a+am $n$+i&ian ini an* &i(a% a%!a) ($n*an !a(i"+"*i

'"!$n#i% />. Namun1 #&u(i &$!)a!u m$nunju%%an )a-5a $n*a+aman !a(i"+"*i %+ini#

($n*an CT (an MRI (aa& (i&$!a%an un&u% "#&m"!&$m ima*in* /2. P$n*u+a#)$!#$!&i6%a& B$)$!aa aan )$!%"+a)"!a#i (a+am u+a#an un&u% m$m)a5a +$)i-

)ana% %$a-+ian #u)#$#ia+i#a#i m$n(a+am &$!-a(a !"#$# $n*am)i+an %$u&u#an

%a!$na &$!+a+u #u+i& )a*i #a&u a-+i !a(i"+"*i un&u% m$ni+ai )$!)a*ai $n&i&a# $na%i&

(i (a$!a- #$+u!u- &u)u-. O+$- %a!$na i&u1 !$7i$5 ini #i#&$m m$mun*%in%an %i&a

un&u% m$n($&$%#i +$#i +$)i- !in,i #$+u!u- &u)u-.


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K$#imu+anna1 -a#i+ $n$+i&ian ini m$nunju%%an )a-5a MDCT (an MRI n"nin7a#i'

(aa& m$m)$!i%an )ana% &$muan '"!$n#i% (a+am #i#&$m #$+u!u- &u)u- -ana a(a

#a&u #,an (a+am 5a%&u an* 5aja!. S$+ain i&u1 #$+u!u- &u)u- CT (an MRI &$muan

an* ,u%u %"n#i#&$n ($n*an &$muan "&"#i@ &$muan u&ama )$na! m$nunju%%an

$n$)a) %$ma&ian (a+am $ma& (a!i +ima %a#u#. MDCT $n,i&!aan ($n*an

!$%"n#&!u%#i 34D a(a+a- ,$a&1 a+a& an* )$!*una un&u% (ia*n"#i# '!a%&u! &u+an*1n$um"&"!a%# ($n*an $m6#$ma #u)%u&an1 (an -i"7"+$mia. MRI m$mi+i%i

%$+$)i-an (a+am m$n($&$%#i +$#i ja!in*an +una%1 &u+an* m$ma!1 $!(a!a-an1 (an

m$+a,a% )$n(a4)$n(a +"*am a&au #$nja&a (a+am &u)u-. D$n*an ($mi%ian1 &u)u-

%$#$+u!u-an4"#&m"!&$m CT (an MRI (i-a!a%an un&u% m$+a%u%an $!an $n&in*

#$)a*ai #%!inin* (an &$# &am)a-an (a+am )i(an* %$("%&$!an '"!$n#i% (i ma#a

($an $n($%.

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