肾透明细胞癌磁共振成像动态增强相对强化指数与微血管密度、增殖细胞核抗原相关性探讨

Relevance of relative contrast enhanced index microvessel density and proliferating cell nuclear antigen in renal clear cell carcinoma with dynamic contrast enhanced MR imaging

目的探讨肾透明细胞癌磁共振成像(MRI)动态增强相对强化指数(RCEI)与肿瘤微血管密度(MVD)、增殖细胞核抗原(PCNA)及核分级的相关性。方法收集32例肾透明细胞癌手术患者,所有患者术前均行1．5 T MRI动态增强扫描,按统一标准测定肿瘤不同增强时期的RCEI。肿瘤标本均行常规苏木精-伊红(H-E)染色检查,并测定肿瘤MVD、PCNA及进行核分级评定。结果MRI动态增强扫描后,肾透明细胞癌均见不同程度强化,强化不均匀,且肿瘤坏死、出血多见。RobsonⅠ-Ⅱ期与RobsonⅢ-Ⅳ期肾癌之间、小肾癌与大肾癌之间在RCEI、MVD、PCNA及核分级方面的差异均有统计学意义(P值均<0．01)。肾透明细胞癌动态增强皮质早期、皮质晚期、实质期RCEI与MVD、PCNA均呈正相关(r=0．38、0．44、0．48和0．45、0．62、0．52, P值均<0．05);MRI增强各期RCEI与肿瘤MVD、PCNA相关系数稍有差异,但无统计学意义(P值均> 0．05)。MRI增强各期RCEI与核分级无明显相关性(P值均>0．05)。结论不同大小及不同分期肾透明细胞癌MRI的RCEI变化与肿瘤MVD、PCNA及核分级变化具有一致性,有可能成为术前评价肿瘤生物学特性的一项重要影像学指标,对肿瘤治疗的选择、评价具有一定价值。

Objective To appraise the relevance of relative contrast enhanced index（RCEI） intra-tumor microvessel density（MVD）, proliferating cell nuclear antigen（PCNA） and nuclear grades in renal clear cell carcinoma with dynamic contrast enhanced MR imaging（DCE-MRI）. Methods Thirty-two patients with renal clear cell carcinoma received DCE MR imaging（MRI） examination, and unified criteria was used to determine RCEI in different tumor enhancing periods after injection of contrast agent. MVD, PCNA and pathological nuclear grades were measured quantitatively in all cases. Results All renal clear cell carcinomas were enhanced to some extent but inhomogeneously, frequently showing tumor necrosis or hemorrhage. There were distinct differences in RCEI, MVD, PCNA and nuclear grades in small and large renal carcinoma and in Robson Ⅲ-Ⅳ and Robson Ⅰ - Ⅱ renal carcinomas （P all 〈 0.01）. However, there was a good correlation between RCEI and MVD, PCNA in early and late DCE- MRI. Conclusion In various sizes and stages of renal clear cell carcinomas, the MRI dynamic RCEI changes are consistent with the changes of tumor MVD, PCNA and nuclear grades. It may be an important imaging marker in pre-operative assessment of tumor biological characteristic and is valuable for selection of tumor treatment. （Shanghai Med J, 2007, 30：343-346）