多层动态容积CT胰腺癌灌注成像的临床应用研究

Clinical application of multi-slice dynamic volume CT perfusion imaging of pancreatic cancer

目的:结合病理及免疫组化结果,探讨多层容积CT灌注成像在胰腺癌术前分化程度评估中的应用价值,进一步探讨其在胰腺癌靶向治疗中的应用前景。方法:回顾性分析40例病理确诊的胰腺癌患者的灌注图像,分别利用最大斜率法及Patlak法获得动脉血流量(artery blood flow,AF)、等效血容量(equivalent blood volume, Equiv BV)及血流萃取(blood flow extraction,FE)值,比较低分化及高分化胰腺癌灌注值之间的差异,运用ROC曲线评估AF值及Equiv BV值的诊断效能;另对40例胰腺癌标本进行PFKFB3免疫组化染色,并分析胰腺癌灌注参数与PFKFB3表达的相关性。结果:低分化胰腺癌组织AF值、Equiv BV值低于高分化胰腺癌组织,差异有统计学意义(P<0.05),FE值之间差异没有统计学意义(P>0.05);AF值对癌组织分化程度的预测效能较高,AUC为0.715,临界值46.88 mL/(min·100 mL),敏感性77.0%,特异性86.0%;PFKFB3表达与AF及Equiv BV值呈负相关(r=-0.744,P=0.00 <0.05;r=-0.518,P=0.028 <0.05),与FE值没有相关性(r=0.066,P=0.082> 0.05)。结论:640层容积CT灌注成像可以用于胰腺癌术前分化程度的初步预测,并有望用于PFKFB3靶点的药物疗效观察。

Objective:To explore the application value of multi-slice volume computed tomography(CT) perfusion imaging in the evaluation of preoperative differentiation of pancreatic cancer combined with pathological and immunohistochemical results,and to further explore its application prospect in targeted therapy of pancreatic cancer.Methods:The perfusion images of 40 patients with pathologically confirmed pancreatic cancer were analyzed retrospectively.Arterial blood flow(AF),equivalent blood volume(Equiv BV) and blood flow extraction(FE) were obtained by maximum slope method and patlak method,respectively.The differences of perfusion values between poorly differentiated and well differentiated pancreatic cancer were compared.The diagnostic efficacy of AF value and Equiv BV value was evaluated by ROC curve.In addition,40 specimens of pancreatic cancer were stained with PFKFB3 immunohistochemical staining,and the correlation between perfusion parameters and PFKFB3 expression in pancreatic carcinoma was analyzed.Results:By contrast to the well differentiated pancreatic tissues,smaller values of AF and Equiv BV were found from poorly differentiated pancreatic cancer tissues, and their differences are statistically significant(P<0.05).However,as for differences in FE values between such two groups,no statistical significance was proved(P>0.05).Furthermore,AF values perform better in predicting differentiation of cancer tissues.Moreover, corresponding AUC,the critical value,sensitivity and specificity were proved to 0.715,46.88 mL/(min·100 mL),77.0% and 86.0%,respectively.Additionally,PFKFB3 expressions was negatively correlated to AF and Equiv BV values(r=-0.744,P=0.00<0.05,r=-0.518,P=0.028<0.05),but uncorrelated to FE values(r=0.066,P=0.082>0.05).Conclusion:640-slice volume CT perfusion imaging can be used for the preliminary prediction of preoperative differentiation of pancreatic cancer,and is expected to be used for the observation of drug efficacy of PFKFB3 target.