肾细胞癌MSCT灌注成像与分子病理学的相关性研究(1)
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【摘要】 目的 运用多层螺旋CT(MSCT)获取肾癌灌注图像,并与其分子病理学特征相对照,探讨MSCT灌注成像在肾癌诊断和鉴别诊断中的临床应用价值。方法 对42例疑有肾肿瘤的患者行 MSC灌注扫描,获得伪彩色的血流灌注参数图,包括血流量(BF)、血容量(BV)、表面通透性(PS)及平均通过时间(MTT)图。在瘤体及瘤旁正常肾皮质选取感兴趣区并记录相应的各项参数值。所有患者均经手术病理证实。采用免疫组化方法(SP法)检测肾肿瘤中血管内皮生长因子(VEGF)的表达及微血管密度(MVD)。结果 肾细胞癌的BF、BV和PS值均明显低于正常肾皮质,且Ⅲ 级肾癌与Ⅰ、Ⅱ级相比,其BF、BV和PS值明显增高。肾癌的BF、BV、PS值与其VEGF平均光密度值呈正相关(P<0.05),MTT值与VEGF平均光密度值呈负相关(P<0.05)。肾癌的MVD值与VEGF值呈正相关(P<0.05)。结论 MSCT灌注成像能定量评价肿瘤血管生成、血流灌注及血管通透性改变,有助于肾细胞癌的术前分级,并在肾癌的定性诊断和鉴别诊断方面有一定临床应用价值。
【关键词】体层摄影术; X线计算机; 灌注成像; 肾肿瘤
Correlative Study between Multi-slice CT Perfusion Imaging and Molecular Pathology in Renal Cell Carcinoma
XIANG Cheng,FENG Chang-shen,XU Rui,et al.Rizhao People’s Hospital,Shandong,Rizhao 276800,China
【Abstract】 Objective To study the correlation of the perfusion CT parameters and the molecular pathology characteristics of the renal cell carcinoma(RCC),and to discuss the value of multi-slice CT(MSCT)perfusion imaging in the diagnosis and differential diagnosis of RCC.Methods 42 patients with clinically suspected renal tumors underwent MSCT perfusion imaging.The maps of renal blood volume(BV),blood flow(BF),permeability surface(PS)and mean transit time(MTT)were obtained.Regions of interest(ROI)were drawn within the tumor and the region of normal area adjacent to the tumor.All of the tumors were proved by surgery and pathology withRCC(n=42).Vascular endothelial growth factor(VEGF)expression and micro-vascular density(MVD)were measured with immuno-histology chemistry technique(SP technique).Results Of the 42RCC,the mean BF,BV and PS value were obviously lower than that of normal renal cortex; moreover,the above-mentioned parameters in grade Ⅲweresignificantly higher than that of grade Ⅰand ⅡRCC.A significant inverse correlation(P<0.05)was observed between the mean MTT value and the VEGF expression.The mean BF,BV and PS of RCC had a significant positive correlation with VEGF expression(P<0.05).Conclusion Tumor angiogenesis,blood flow perfusion and permeability surface could be quantitatively evaluated by MSCT perfusion imaging.It provides useful information for pre-surgical staging of RCC and benefit s the clinical diagnosis and differential diagnosis of RCC.
【Key words】Tomography,X-ray computed; Perfusion imaging; Renal neoplasms
CT灌注成像因能定量判断活体组织,特别是肿瘤的血流动力学状况而成为近年来研究的热点,已初步应用于脑、心脏、肝、脾、胰等多种器官功能成像,并取得了可喜的进展[1]。随着多层螺旋CT的临床应用及灌注软件的改进,这方面的研究和应用正方兴未艾。目前关于肾肿瘤MSCT灌注成像国内鲜有报道,且多为动物实验,与临床的联系不够紧密。本研究应用MSCT灌注成像对肾癌的血流状况进行定量分析,并与其分子病理学特征相对照,旨在探讨MSCT灌注成像在肾癌定性诊断和鉴别诊断方面的临床应用价值。
1 材料与方法
2006年8月至2009年5月对我院42例经B超或CT平扫发现肾脏肿瘤的患者进行MSCT灌注成像,其中男33例,女9例,年龄43~67岁,平均52 ......
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