脑胶质瘤肿瘤血管生成的T2加权增强血管成像评价

Evaluation of glioma tumor angiogenesis using enhanced T2 star weighted angiography

目的探讨T2*加权增强血管成像(enhanced T2star weighted angiography,ESWAN)参数指标与脑神经胶质瘤微血管密度(microvessel density,MVD)、血管内皮生长因子(vascular endothelial growth factor,VEGF)间的相关性。方法对53例临床疑似脑胶质瘤患者行ESWAN检查,原始数据传至ADW 4.3工作站,得到ESWAN最小密度投影图(minimum intensity projection,ESWANMinIP)、相位图(phase image,PI),分别测量肿瘤感兴趣区(ROI)及对侧正常脑白质的参数:R2*值、T2*值及Phase值;记录ESWANMinIP上肿瘤实质区出血灶及血管结构数目,并对其分级。病理标本免疫组织化学染色,测定MVD计数和VEGF表达,单因素方差分析脑胶质瘤与对侧正常脑白质R2*值、T2*值及Phase值的差异性;应用Spearman相关性检验分析MVD、VEGF与ESWAN各参数指标的相关性;不同级别脑胶质瘤与瘤内出血及血管数目分级间的差异性采用Kruskal-Wallis H秩和检验。结果不同级别胶质瘤病灶T2*、Phase的平均值明显高于对侧正常脑白质,差异有统计学意义(P<0.05);R2*的平均值也与正常脑白质差异有统计学意义(P<0.05)。感兴趣区内,T2*值与MVD呈负相关(r=-0.642,P<0.05),R2*值与MVD呈正相关(r=0.765,P<0.05),Phase值与MVD呈正相关(r=0.811,P<0.01);T2*值在VEGF阳性表达组(11.178±2.911)Ms,阴性组(23.263±2.383)Ms,差异具有统计学意义(P<0.01),R2*值在VEGF表达阳性组(12.611±1.967)Hz,阴性组(5.316±0.767)Hz,差异有统计学意义(P<0.01),Phase值在VEGF表达阳性组(1.086±0.017)Radian,阴性组(1.386±0.021)Radian,差异无统计学意义(P>0.05)。除Ⅰ级与Ⅱ级、Ⅰ级与Ⅲ级间肿瘤内出血及血管成分差异无统计学意义外,余各组的两两比较差异均有统计学意义(P<0.01)。结论ESWAN参数指标与脑胶质瘤MVD、VEGF相关,在非侵袭性评价脑胶质瘤血管生成方面有重要价值。

Objective To investigate the relationship between enhanced T2 star weighted angiography （ESWAN）parameter indexes and the microvessel density （MVD）and vascular endothelial growth factor （VEGF） glioma patients.Methods A total of 53 cases with suspected gliomas were examined by ESWAN.All raw data were transferred to ADW 4.3 workstation,the minium intensity projection （ESWANMinIP）and phase image （PI）were obtained.Tumor areas of interest return-on-investment （ROI）and contra lateral normal white matter of brain of parameters including R2＊ value,T2＊ value and phase value were calculated,respectively.The structures and number of the vessels were observed on ESWANMinIP,and its classification was recorded.Pathologic specimens were stained by immunohistochemistry,MVD count and VEGF expression were determinated.The difference in R2＊ value,T2＊value and phase value between glioma and contra lateral normal white matter of brain were tested by one-way ANOVA test.Spearman correlation test was applied to analyze the correlation between MVD,VEGF and ESWAN of each parameter.Bleeding and classification of vessel number in different grade glioma were detected by Kruskal-Waltis H test.Results The average values in T2＊ and phase value were significantly higher in glioma than in the contra lateral normal white matter （P 〈 0.05 ）.The average value in R2 ＊ values between glioma and the contra lateral normal white matter had significant difference （P 〈0.05）.In ROI,T2＊ values were negatively correlated with MVD （r =-0.642,P 〈0.05）,R2＊ and phase values were positively correlated with MVD （r =0.765 and 0.81 1,P 〈0.05 and 〈0.01,respectively）.The expression of VEGF in group T2＊ was significantly lower in the positive group than in the negative group （1 1.1 78±2.91 1）Ms vs （23.263±2.383）Ms（P 〈0.01）.The expression of VEGF in group R2＊was significantly higher in the positive group than in the negative group （12.61 1±1.967）Hz vs （5.31 6±0.767）Hz （P 〈0.01）.Phase value showed no significant difference between the positive group and the negative group in group （P 〉0.05）.There were no significant difference in intratumoral hemorrhage and vascular component among class Ⅰ and class Ⅱ,class Ⅰ and class Ⅲ,the others showed significant difference （P 〈0.01）.Conclusion ESWAN parameter indexes were associated with MVD and VEGF in brain glioma,they had important value in the noninvasive evaluation of brain glioma angiogenesis.