乳腺病变动态增强MRI与血管生成的相关性

Correlative study of the parameters of dynamic contrast-enhanced MRI and angiogenesis in breast lesions

目的探讨乳腺良、恶性病变 MR 动态增强(DCE)参数与肿瘤血管生成的关系。方法对51例乳腺良、恶性病变患者行前瞻性 DCE-MR 检查,计算动态增强参数:最大增强线性斜率(S_(max)、增强峰值(PH)、峰值时间(T_(peak))。所有病例手术病理标本行免疫组织化学染色,测定微血管密度(MVD)计数和血管内皮生长因子(VEGF)表达,分析各动态增强参数与乳腺癌 MVD 和 VEGF 表达的相关性。并比较29例乳腺癌与12例乳腺纤维腺瘤、10例乳腺病、10例癌旁正常组织 MVD 计数和VEGF 表达的差别。结果乳腺癌 S_(max)(2.04±1.8;r=0.807,P<0.01)、PH(678±260;r=0.697,P<0.01)与 MVD 呈正相关,T_(peak)(69±38)与 MVD 呈负相关(r=-0.425,P<0.05)。乳腺癌组MVD 计数[(65.09±15.81)个/200倍视野]明显高于纤维腺瘤组、乳腺腺病组及癌旁正常组织组(P 值分别为0.043、0.018、0.002)。69%(20/29)乳腺癌 VEGF 表达阳性,也明显高于其余各组(P 值分别为0.035、0.007、0.001)。乳腺癌边缘区域的 MVD(60.38±24.14)个/200倍视野,高于中央区域(37.64±16.52)5个/200倍视野;(t=2.635,P=0.016)。腋窝淋巴结转移组的 MVD(73.23±23.02)个/200倍视野,高于无转移组(59.34±18.03)个/200倍视野,(t=2.303,P=0.031)。结论乳腺癌部分 MR-DCE 参数与 MVD、VEGF 相关,能较客观地反映乳腺癌血管生成状况,其 MVD 计数和 VEGF 表达明显高于乳腺良性病变及癌旁正常组织。

Objective To evaluate the relationship between dynamic contrast-enhanced MRI （ DCE- MRI） -derived parameters and tumor angiogenesis in malignant and benign breast lesions. Methods Fiftyone patients with malignant and benign breast lesions underwent DCE-MRI using a Philips Intera 1.5 T MR System and dedicated breast coil prospectively before operation. DCE-MRI derived parameters such as steepest slope （ Smax ）, peak height （ PH ）, time-to-peak （ Tpeak ） were calculated based on time-signal intensity curve. The micro-vessel density （MVD） was counted and vascular endothelial growth factor （VEGF） expression was assessed in these patients after operation with immunohistochemical staining method. The parameters were correlated statistically with MVD counts and VEGF expression in breast cancer. The MVD counts and VEGF expression were also compared among the patients with breast cancer （29 cases）, with fibroadenoma （12 cases）, mastopathy （10 cases） and the normal tissue （10 cases）. Results The enhancement parameters Smax（ r =0. 807 ,P 〈0. 001 ） ,PH （ r =0. 697 ,P 〈0. 001 ） correlated positively with MVD respectively. Tpeak （69 ± 38 ） correlated negatively with MVD counts（ r = -0. 425, P 〈 0. 05 ）. The mean value of MVD （65.09 ± 15.81/200 times field） in patients with breast cancer were significantly higher than those with fibroadenoma, mastopathy or normal tissue （P = 0. 043, 0. 018, 0. 002 respectively）. 69% （20/29 cases） of breast cancers demonstrated positive VEGF expression, which were significantly more than that of fibroadenoma, mastopathy or normal tissue （P = 0. 035,0. 007, 0. 001 respectively）. Moreover, the MVD counts （60. 38 ±24. 14） in the peripheral region of breast cancer were more than those in central region （ 37. 64 ± 16. 52 ; t = 2. 635, P = 0. 016 ）. There was a significant difference in MVD counts between breast cancers with metastasis to axillary lymph nodes （ 73.23 ± 23.02 ） and those without metastasis （ 59. 34 ± 18. 03 ）, （ t = 2. 303, P = 0. 031 ）. Conclusions Some parameters derived from DCE-MRI correlated positively with MVD counts and VEGF expression in patients with breast cancer, which may reflect tumor angiogenesis. The MVD counts and VEGF expression in patients with breast cancer were significantly more than those in patients with benign lesions.