食管鳞癌淋巴结转移与CT灌注参数及血管生成的关系

Correlation of lymph node metastasis with CT perfusion parameters and angiogenesis in esophageal squamous cell carcinoma

目的:探讨食管鳞癌淋巴结转移与其CT灌注参数及血管生成的关系。方法:50例食管癌患者行MSCT灌注扫描,采用免疫组织化学SP法检测术后标本中MVD及VEGF的表达。分析食管癌淋巴结转移与CT灌注参数中血容量(BV)、血流量(BF)、平均通过时间(MTT)、表面通透性(PS)及MVD、VEGF表达之间的关系。结果:食管鳞癌CT灌注参数中BF、BV、MTT值在有和无淋巴结转移组中分别为(128.81±50.05)和(105.55±43.18))ml/(100g.min)、(7.64±3.11)和(6.33±1.71)ml/100g、(5.62±1.97)和(7.16±3.32)s,差异均无统计学意义(P>0.05),而PS值在有和无淋巴结转移组分别为(18.32±5.39)和(9.66±2.46)ml/(100g.min),差异有高度统计学意义(P<0.01);以PS值>10ml/(100g.min)为阈值预测淋巴结转移的敏感度、特异度、阳性及阴性似然比分别为95.8%、65.4%、2.77和0.06;VEGF及MVD值与食管鳞癌淋巴结转移有显著正相关关系(r值分别为0.752和0.384,P<0.01)。结论:CT灌注成像有助于食管鳞癌淋巴结转移的术前诊断,其中PS值是最有价值的诊断指标。

Objective：To evaluate the relationship of lymph node metastasis with CT perfusion parameters and angiogenesis in esophageal squamous cell carcinoma. Methods： Multi-detector row spiral CT （MDCT） perfusion was performed in 50 patients with esophageal carcinoma. The micro-vascular density （MVD） and VEGF expression were examined by means of SP immuno-histochemical technique. The correlation of lymph node metastasis with CT perfusion parameters,including blood volume （BV）, blood flow （BF）,mean transit time （MTT）,surface permeability （PS）, MVD and VEGF expression were analyzed. Results：The BF,BV and MTT values of esophageal squamous cell carcinoma with and without lymph node metastasis were （128. 81± 50. 05） ml/（100g·min）, （7. 64±3. 11） ml/100g, （5. 62± 1. 97） s and （105. 55± 43.18）ml/（100g·min） ,（6.33±1.71）ml/100g,（7.16±3.32）s respectively,with no significant statistical differences （P〉0.05）. Significant difference of the PS value [ （18.32 ±5.39） vs （9.66 ± 2.46）ml/（100g · min）] was found between patients with or without lymph node metastasis （P〈0.01）. Taking PS value （〉10ml/100g·min） as the threshold for the diagnosis of lymph node metastasis, the sensitivity, specificity, positive and negative likelihood ratio were 95.8%, 65.4%, 2.77 and 0.06 respectively. The lymph node metastasis showed positive correlation to MVD and VEGF expression with r values as 0. 752 and 0. 384 respectively （P〈0.01）. Conclusion：CT perfusion imaging is helpful for the preoperative diagnosis of lymph node metastasis in esophageal squamous cell carcinoma,and PS value is the most valuable diagnostic index.