肾细胞癌螺旋CT表现与肿瘤血管生成的相关性研究

Correlation between spiral CT features and tumor angiogenesis in renal cell carcinoma

目的 探讨肾细胞癌(RCC)螺旋CT同层动态扫描表现与癌组织微血管密度(MVD)、癌细胞血管内皮生长因子(VEGF)蛋白表达之间的相关关系。方法 对18例肾细胞癌患者行螺旋CT靶平面同层动态扫描,计算动态CT各指标,包括曲线升段斜率(S)、曲线下面积(AR)、增强后CT增加值(△HU)、组织血管比(TBR)。时间-密度曲线(T-DC)类型按升段斜率由小到大分为A、B、C型。组织切片经CD34单克隆抗体及VEGF多克隆抗体免疫组织化学染色。采用图像分析仪计数“热点”(hot spot)MVD、VEGF蛋白表达量,并观察肾细胞癌微血管分布。结果 (1)癌组织MVD与动态CT指标S、△HU、AR、肿瘤曲线分型之间呈极显著性相关(r=0.51、0.56、0.50、0.57,P<0.01),与TBR呈显著相关性(r=0.51,P<0.05)。VEGF蛋白表达量与MVD及动态CT各指标间均无显著相关性(r=0.30、0.03、0.12、0.08、0.10、0.01,P>0.05)。(2)据T-DC升段斜率不同,所分A、B、C型。RCC间增强CT表现差异有显著性意义(F=9.84、12.17、24.00,P<0.05)。结论 动态螺旋CT扫描可无创评价肿瘤血管生成。

Objective To investigate the correlation of certain features of spiral CT (S-CT) with tumor microvascular density (MVD) and vascular endothelial growth factor (VEGF) in renal cell carcinoma (RCC). Methods For each of the 18 pathologically proved RCC cases, single slice dynamic scans were performed by spiral CT, Enhancement indexes were as follows; the slope of the contrast media uptake curve (S) , area under the curve (AR) ,△HU, and TBR. The indexes were calculated for all lesions. Time-density curve types were ranked from the lowest to the highest of the slope of the contrast media uptake curve (S) as type A, B, and C. CD34 monoclonal antibody and VEGF polyclonal antibody immunohistochemical staining were performed in each cases, then the ' hot spots' of MVD and VEGF protein expression were counted with image analyzer. The distributions of microvessels on the slides were also observed. Results (1)Tumor MVD had significant correlation with S,△HU, TBR, AR, and T-DC types (r =0.51, 0.56, 0. 5 , and 0. 57, P < 0. 01). There was no correlation between VEGF protein expression and MVD and each of enhancement parameters (r = 0. 30, 0. 03 , 0. 12, 0. 08, 0. 10, 0. 01, P > 0. 05 ). (2) Differences of CT features in RCC were shown, as well as that of tumor angiogenesis. Conclusion Dynamic spiral CT scan is helpful to assess the tumor vascularity and angiogenesis, thus is useful for clinical evaluation and prediction of its prognosis.