胃癌CT灌注参数和组织学特征的关系

The Relationship Between CT Perfusion Parameters and Histological Features of Gastric Cancer

目的探讨胃癌CT灌注参数和组织学特征的相关性。方法选取106例经病理证实的胃癌患者作为研究对象,依据病理结果将低分化腺癌、黏液腺癌和印戒细胞癌患者划分为低分化组(n=48),中分化腺癌和高分化腺癌患者划分为中高分化组(n=58)。比较2组患者多层螺旋CT灌注成像的血流量(BF)、达峰时间(TTP)、Patlak血容量(PBV)、Patlak表面通透性(PPS)参数值,采用ROC曲线分析CT灌注成像参数值对胃癌组织低分化与中高分化的判断效能,并检测2组患者的血清甲胎蛋白(AFP)、糖类抗原199(CA199)和糖类抗原72-4(CA72-4)水平,分析其与CT灌注成像参数值的相关性。结果低分化组患者BF、PBV和PPS值均高于中高分化组(P<0.05),TTP值低于中高分化组(P<0.05);ROC分析结果显示,CT灌注参数BF、TTP、PBV和PPS值联合评估胃癌患者组织低分化和中高分化的曲线下面积(AUC)高于四项参数单独判断的AUC值(P<0.05)。低分化组患者血清AFP、CA199和CA72-4水平均高于中高分化组(P<0.05),且血清AFP、CA199和CA72-4分别与胃癌患者CT灌注参数BF、PBV和PPS值呈正相关性(P<0.05),与TTP值呈负相关性(P<0.05)。结论胃癌患者CT灌注参数BF、TTP、PBV和PPS与组织分化程度有关,并与血清肿瘤标志物具有良好相关性,四项参数的联合检测对评估胃癌患者组织分化程度的效能较高。

Objective To explore the correlation between CT perfusion parameters and histological features of gastric cancer.Methods A retrospective selection was performed on the 106 patients pathologically confirmed with gastric cancer.According to the pathological results,the patients with low differentiation of adenocarcinoma,mucinous adenocarcinoma and signet-ring cell carcinoma were enrolled as low differentiation group(n=48),while patients with moderate to high differentiation of adenocarcinoma were enrolled as moderate-high differentiation group(n=58).The parameters of multi-slice spiral CT perfusion imaging[blood flow(BF),time to peak(TTP),patlak blood volume(PBV),patlak permeability surface(PPS)]between the 2 groups were compared.The determining efficiency of CT perfusion parameters for low and moderate differentiation of gastric cancer tissues was analyzed by ROC curves.The levels of serum alpha-fetoprotein(AFP),carbohydrate antigen 199(CA199)and carbohydrate antigen 72-4(CA72-4)in both groups were detected.And their correlation with CT perfusion parameter was analyzed.Results BF,PBV and PPS in low differentiation group were higher than those in moderate-high differentiation group(P<0.05),while TTP was lower than that in moderate-high differentiation group(P<0.05).ROC analysis showed that area under the curve(AUC)of BF combined with TTP,PBV and PPS for evaluating low differentiation and moderate to high differentiation of gastric cancer tissues was greater than that of single index(P<0.05).The levels of serum AFP,CA199 and CA72-4 in low differentiation group were higher than those in moderate-high differentiation group(P<0.05).The serum AFP,CA199 and CA72-4 were positively correlated with BF,PBV and PPS(P<0.05),while negatively correlated with TTP(P<0.05).Conclusion CT perfusion parameters(BF,TTP,PBV,PPS)are related to the degree of tissue differentiation in patients with gastric cancer,and there are good correlation between the four indexes and serum tumor markers.The combined detection of the four parameters is of high evaluation efficiency for tissue differentiation in gastric cancer patients.