多层螺旋CT灌注成像对兔VX2肝移植瘤无水酒精介入治疗疗效的评价

Evaluation of rabbit VX2 liver tumors before and after absolute alcohol injection by perfusion imaging of multi-slice helical CT

目的 探讨MSCT灌注成像对兔VX2肝移植瘤无水酒精介入治疗后疗效评价的价值.方法 15只日本长耳大白兔按数字表法随机分成实验组及对照组,均接种VX2肝移植瘤,对照组5只兔于肿瘤接种后14 d行肝MSCT灌注扫描后牺牲,取肿瘤边缘组织行免疫组织化学分析,观察微血管密度（MVD）.实验组10只兔于肿瘤接种后14 d行MSCT灌注扫描后行开腹肿瘤内无水酒精介入治疗,再于介入治疗后3及30 d行CT灌注扫描,牺牲后取肿瘤边缘组织行免疫组织化学分析,对比肿瘤边缘组织CT灌注参数,包括肝血流量（BF）、血容量（BV）、平均通过时间（MTT）、毛细血管表面通透性（PS）、肝动脉灌注指数（HAF）和肝动脉灌流量（HAP）的变化规律.应用重复测量方法比较实验组兔无水酒精介入治疗前后不同时间肿瘤边缘区CT灌注参数的变化,采用独立样本t检验比较实验组与对照组间的MVD结果,对照组灌注参数与MVD结果比较采用线性相关性分析.结果 肿瘤周边区治疗前、治疗后3及30 d BF分别为（280.62±59.87）、（322.03±86.94）、（177.05±75.%）ml·min-1;HAF分别为0.59±0.08、0.89±0.12、0.23±0.07;HAP分别为（189.26±25.46）、（251.57±31.78）、（40.90±5.17）ml·min-1·m-1.治疗后3 d HAP较治疗前明显升高（P＜0.05）;治疗后30 d较治疗后3 d BF、HAF、HAP均降低（P均＜0.05）;治疗后30 d较治疗前BF、HAF、HAP均降低（P均＜0.05）.对照组移植瘤种植后14 d BF、PS、HAF、HAP与MVD呈正相关（r值分别为0.916、0.726、0.870、0.889,P＜0.05）.实验组介入治疗后30 d MVD（21.8±3.5）条/高倍视野（HP）较对照组MVD（43.9±4.0）条/HP减低（t=12.271,P＜0.05）.结论 CT灌注成像可评价兔VX2肝移植瘤无水酒精介入前后的肝血流动力学改变,可以代替MVD评价肿瘤的血管生成.

Objective To study the hemodynamic changes of rabbit VX2 liver tumors before and after ethanol injection by perfusion imaging of MSCT and investigate the correlation between perfusion parameters and microvessel density （MVD）. Methods All of 15 Japanese long-ear white rabbits were divided into control group and experiment group. All rabbits were inoculated with VX2 liver tumor. Perfusion imaging of MSCT scans were conducted in 5 rabbits in the control group on the 14 th day after VX2 tumor inoculation, and the borders of the tumors were stained with immunohistochemical stains, and MVD was measured by anti-CD34. Perfusion imaging of MSCT scans were conducted in all 10 rabbits in the experiment group on the 14 th day after VX2 tumor inoculation. Then absolute alcohol was injected into the tumors by laparotomy. CT scans were conducted 3 and 30 days after absolute alcohol injection, and the borders of the tumors were stained immunohistochemically, and MVD was measured by anti-CD34. The differences of perfusion parameters such as hepatic blood （ BF）, hepatic blood volume （BV）, mean transit time （ MTT）,permeability of capillary vessel surface （PS）, and hepatic arterial fraction （HAF）, hepatic arterial perfusion （HAP） were compared to evaluate the liver hemodynamic changes. Statistical repeated measurement t test, correlation analysis were performed. Results BF of border of the tumor between pretreatment, 3 days after ethanol injection and 30 days after ethanol injection were （ 280. 62 ± 59. 87 ）,（322.03 ± 86. 94 ）, （ 177.05 ± 75.96） ml · min -1; HAF were 0. 59 ± 0. 08, 0. 89 ± 0. 12, 0. 23 ± 0. 07;HAP were （ 189. 26 ± 25.46）, （ 251.57 ± 31.78 ）, （40. 90 ± 5.17 ） ml · min - 1 · ml - 1. HAP increased significantly after ethanol injection 3 days （ P 〈 0. 05 ）; BF, HAF, HAP decreased significantly 30 days after ethanol injection compared with 3 days after ethanol injection （ P 〈 0. 05 ）; BF, HAF, HAP decreased significantly 30 days after ethanol injection compared with pre-treatment （ P 〈 0. 05 ）. It showed positive correlation between BF, PS, HAF, HAP and MVD （r=0. 916, 0. 726, 0. 870, 0. 889; P 〈0. 05）. MVD decreased significantly compared with the control group （43.9 ± 4. 0）/HP 30 days after ethanol injection （21.8±3.5）/HP （t = 12.271, P 〈0.05）. Conclusion Perfusion imaging of MSCT can detect the hemodynamic changes in rabbit VX2 liver tumors, and also in tumors before and after ethanol injection. CT perfusion can take the place of MVD to evaluate the tumor angiogenesis.