MSCT灌注成像对肾癌术前诊断价值的前瞻性研究

Application value of MSCT perfusion imaging in the pre-surgical diagnosis of renal cell carcinoma

目的:探讨多层螺旋CT(MSCT)灌注成像术前对肾细胞癌(RCC)的定性诊断、肿瘤分期、肾血流及肿瘤血管生成的评估等方面的临床应用价值。方法:对38例肾细胞癌、18例肾盂癌、8例肾错构瘤患者行MSCT靶平面同层动态增强扫描,经过灌注软件处理分析,获得正常肾皮质及肾肿瘤组织的伪彩色血流灌注参数图,在瘤体、瘤旁及对侧正常肾皮质分别选取感兴趣区域并记录、分析相应各项参数值及时间-密度曲线,以评价组织器官的灌注状态。结果:①各级别肾癌间及肾癌与正常肾皮质的血流量、血容量及增强峰值差异均有显著性意义;②肾癌血流量、血容量、表面通透性及增强峰值均高于肾盂癌,以II、III级尤为明显;③肾癌峰值时间早于正常肾皮质,亦早于肾盂癌及肾错构瘤,差异有显著性意义。④II、III级肾癌MTT值明显小于正常肾皮质,肾癌、肾盂癌及肾错构瘤间MTT值差异无显著性意义;⑤肾癌灌注值显著高于肾盂癌及肾错构瘤。结论:肾癌MSCT灌注成像有一定的特点,在肾癌的术前定性诊断、肿瘤分期、肾血流及肿瘤血管生成的无创评估等方面具有较大的临床应用价值。

Objective： To evaluate the value of multiple spiral CT （MSCT） perfusion imaging in the pre-surgical diagnosis, staging, assessing the renal blood flow and the tumor angiogenesis of renal cell carcinoma（RCC）. Methods： The study included 38 cases of RCC, 18 cases of renal pelvic carcinoma （RPC） and 8 cases of renal angiomyolipoma （RAML） proved by surgery and pathology. Targetlice dynamic perfusion scanning was performed in all patients before surgery. Regions of interest（ROI） were drawn within the tumor, the region of normal area adjacent to the tumor and the other side. Relevant parameters including blood flow（BF）, blood volume（BV）, mean transit time（MTF）, permeability surface（PS） and time-density curve（TDC） were analyzed using perfusion software. Result： （1）There were significant association for BF, BV and PE between different tumor cell grades, RCC and normal renal cortex. （2）Of the 38 RCC, especially the grade II and III, the mean BF, BV, PS and peak en hancement（PE） value were higher than that of RPC. （3）The time of peak（PT） of RCC were obviously earlier than that of nor- mal renal cortex, RPC and RAML. There were significant differences between them. （4）The MTT value of grade II and III RCC were obviously lower than that of normal renal cortex. There were no significant differences of MTT between RCC, RPC and RAML. （5）Perfusion of RCC was much higher than that of RPC and RAML. Conclusion： There are distinctive characteristics of MSCT perfusion imaging in RCC, which help to assess the renal blood flow and the tumor angiogenesis and provides useful information for pre-surgical diagnosis and staging of RCC. MSCT perfusion imaging is a promising technique for clinical evaluation and prediction of prognosis in RCC.