肾细胞癌MSCT灌注参数与血管生成、细胞增殖的相关性研究

Correlation Research of MSCT Perfusion Parameters with Angiogenesis,Cell Proliferation in Renal Cell Carcinoma

目的探讨肾细胞癌多层螺旋CT(MSCT)灌注扫描参数与肿瘤微血管密度(MVD)、增殖细胞核抗原Ki-67的相关性。资料与方法选择24例经手术病理证实肾细胞癌的患者与15名健康自愿者,行肾区CT平扫后选择经肿瘤的最大层面或正常肾脏选肾门平面为靶平面再行同层动态增强扫描,经过灌注软件处理分析分别获得肾癌组织及双侧肾皮质的血流量(BF)、相对血容比(rBV)、平均通过时间(TTP)、通透性(Pm)及时间密度曲线(TDC图)。24例肿瘤组织切片采用免疫组织化学方法(SP法)检测肾肿瘤中MVD计数和Ki-67的表达。将所获灌注参数与相应免疫组织化学指标进行比较研究。结果(1)各级别肾细胞癌间及肾细胞癌与正常肾皮质BF、rBV、Pm差异均有统计学意义。各级别肾细胞癌间及肾细胞癌与正常肾皮质TTP差异无统计学意义。(2)各级别肾细胞癌间MVD和Ki-67差异均有统计学意义。(3)CT灌注参数中,BF、rBV、Pm与肾细胞癌MVD和Ki-67有明显相关关系;TTP与MVD和Ki-67间无显著相关性。结论MSCT灌注成像能定量检测肾细胞癌血流灌注和血管通透性改变,有助于推测肾细胞癌的术前分级,评价肿瘤血管生成、细胞增殖状态,为术前诊断及治疗提供依据。

Objective To investigate the correlation of MSCT perfusion parameters with tumor microvessel density （MVD） and Ki 67 antigen in renal cell carcinoma （RCC）. Materials and Methods The study included 24 cases of RCC proved histopathologically and 15 healthy volunteers as control. Target slice dynamic enhanced scanning was performed by MSCT for all patients. Parameters including blood flow （ BF）, relative blood value （ rBV ）, time to peak （ TTP）, permeability （Pro） and time density curve （TDC） were analyzed using perfusion software. MVD and Ki 67 antigen expression were measured with immunohistology chemistry technique （ SP technique）. The results were compared with MSCT perfusion paraments. Results （ 1 ） There were significant differences for BF, rBVand Pm between different tumor cell grades, RCC and normal renal cortex. There was no significant correlation for TTP between different tumor cell grades, RCC and normal renal cortex. （2）There were significant differences for MVD and Ki 67 antigen between different tumor cell grades. （3）CT perfusion parameters,including BF,rBV and Pm had significant correlations with MVD and Ki 67 antigen of lesions. TTP had no correlation with MVD and Ki 67 antigen of lesions. Conclusion Blood flow perfusion and permeability of RCC could be quantitatively measured by MSCT perfusion imaging. MSCT perfusion provides important information of tumor angiogenesis and cell multiplication,which is useful to predict staging and treatment of RCC presurgery.