CT灌注成像评价非小细胞肺癌抗血管生成治疗

Perfusion computed tomography permits the assessment of non-small-cell lung cancer treated with anti-angiogenic therapy

CT灌注成像作为一种无创性的功能性影像学成像检查方法,能够反映出非小细胞肺癌的血管生成情况,并且通过血管的变化情况来评价非小细胞肺癌对抗血管生成治疗药物的治疗反应。相比以往的RECIST评价方式,CT灌注成像在治疗伊始就可以提供肿瘤变化情况的信息。基于非小细胞肺癌的血管生成原理,CT灌注成像的主要评价指标包括血流量、血容量、对比剂的平均通过时间、毛细血管通透性以及强化峰值等灌注参数。而CT灌注成像对于"血管正常化"的指标的分析将可以影响对非小细胞肺癌预后和疗效的预测评价。非小细胞肺癌的微血管管腔化程度以及血管内皮生长因子的表达与CT灌注成像评价指标之间也存在密切联系,而非小细胞肺癌的病理分级和组织学分型的不同也在CT灌注成像的评价中有着重要影响。由于技术层面的限制,灌注参数的可重复性较差,患者接受的放射剂量过大及造影使用的对比剂的毒性等,这种方法的应用推广仍然存在很大问题。相信随着更多分子影像标志物的出现和抗血管生成靶向治疗药物的发展,应用CT灌注成像的方法对非小细胞肺癌的抗血管生成治疗进行临床评价将可能有更大的发展空间。

As a non-invasive functional radiographic imaging method, perfusion computed tomography （PCT） permits the evaluation of non-small-cell lung cancer （NSCLC） angiogenesis and response to therapy by demonstrating alterations in NSCLC vascularity. PCT performed shortly after initiating therapy may provide a better evaluation of physiological changes rather than conventional size assessment obtained by response evaluation criteria in solid tumors. Based on the angiogenesis principle of NSCLC, the main evaluation indexes of PCT are blood flow, blood volume, mean transit time, permeability surface, and peak enhancement index. The relationship between PCT and the indexes of ＂vascular normalization＂ may have implications for exploring the predictive model of efficacy and prognostic factors of NSCLC. The cavity of microvessel in NSCLC and expression of VEGF factors are closely related to PCT imaging. According to PCT assessment, pathological classification and histological type of NSCLC play significant roles. However, technical limitations, reproducibility of blood flow parameters, radiation dose, and volume of contrast medium delivered to the patient are some issues in this type of investigation. With the development of PCT technology and anti-angiogenesis drugs for NSCLC, more molecular imaging markers and standardized targeted therapies will be available. Such advancements will provide a wider space for the assessment of NSCLC treated with anti-angiogenic therapy using PCT.