肾上腺腺瘤和非腺瘤动态增强CT表现与血管生成相关性的初步研究

Adrenal adenomas and nonadenomas: the preliminary study of correlation between appearances of dynamic contrast-enhanced CT and tumoral angiogenesis

目的探讨肾上腺腺瘤和非腺瘤血管生成[微血管密度(MVD),血管内皮生长因子(VEGF)]特点与动态增强CT表现的相关性,以阐述其动态增强机制。方法经手术病理证实的42例46个肾上腺肿块(腺瘤23个、非腺瘤18个、增生结节5个)均行动态增强CT检查和病理学检查。首先评价肾上腺腺瘤和非腺瘤动态增强CT表现,而后分析肾上腺肿块动态增强CT表现特征[时间密度(TD)曲线、廓清率(Wash)]与血管生成之间的相关关系。结果腺瘤与非腺瘤间TD曲线类型和7min延时点相对廓清率(Washr)和绝对廓清率(Washa)差异均存在统计学意义(P=0.000)。肾上腺肿块TD曲线廓清迅速组(A、C型)与廓清缓慢组(B、D、E型)间、7min延时点Washr≥34%组与<34%组间、Washa≥43%组与<43%组间MVD、VEGF表达水平差异均有统计学意义(P<0.05)。肿块廓清曲线为A、C型,和(或)Washr≥34HU,和(或)Washa≥43%组均提示为腺瘤,反之提示为非腺瘤。TD曲线廓清迅速组、7min延时点Washr≥34%组和Washa≥43%组MVD、VEGF表达水平分别高于廓清缓慢组、<34%组和<43%组;由此提示动态增强CT表现特征与MVD、VEGF表达存在相关性。另一方面,腺瘤和非腺瘤间MVD和VEGF表达存在显著不同。结论MVD和VEGF可能是导致腺瘤和非腺瘤具有不同的TD曲线类型和廓清率的主要因素之一。.

Objective To analyze the correlation between the typical findings of dynamic contrastenhanced CT （DCT） and tumoral angiogenesis[ microvessel density, MVD and vascular endothelial growth factor, VEGF] of adenoma and nonadenoma and elucidate the mechanism of enhancement on DCT. Methods Forty-two cases with 46 adrenal masses proven surgically and pathologically were included in the study,which was composed of 23 adenomas, 18 nonadenomas and 5 hyperplastic nodules. DCT and angiogenesis were studied in all adrenal masses. Appearances of DCT of adenoma and nonadenoma were first evaluated,and then, to further explore whether enhanced characteristics of DCT of adrenal masses were closely correlated with tumoral angiogenesis. Results Adrenal adenoma was significantly different from nonadenoma in T-D curve, 7min-delayed Washr and Washa of DCT. The mean MVD and VEGF expression had significant difference between Group faster Wash （type A, C ） and Group slower Wash （type B, D, E ）, 7min-delayed Washr≥34% and Washa≥43%, and 7min-delayed Washr≥34% and Washa≥43% （P =0. 000） Adenomas were suggested when adrenal masses presented as Type A and C, and/or Washr≥34% ,and/or Washa≥43%, vice versa, nonadenoma. These findings showed close correlation of both enhancement appearances of DCT and MVD and VEGF expression of adrenal masses. On the other hand, there was significant difference in MVD and VEGF expression between adenoma and nonadenome, Conclusion MVD and VEGF were the main pathological factors of DCT of adrenal masses, which resulted in different T-D curve, Washr and Washa of adrenal DCT.