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目的探讨256层螺旋CT结直肠癌全肿瘤灌注成像与肿瘤分期及肿瘤内血管生成相关性。方法对2010年7月至2012年11月在本院普外科术前经纤维结肠镜检查并由术后病理证实的结直肠腺癌患者37例[男23例,女14例,年龄(64.54±11.66)岁]进行256层螺旋CT全肿瘤灌注分析,并对术后标本多层面取材,采用鼠抗人单克隆抗体CD105(Anti-CD105/Endoglin)进行免疫组织化学染色,以患者为单位测定肿瘤组织内血管生成情况。将全肿瘤灌注参数与临床病理参数(TNM分期、淋巴结及远处转移)、肿瘤内血管生成情况进行分析比较。分别运用Spearman相关性检验、Pearson相关性检验分析全肿瘤灌注参数与肿瘤TNM分期、肿瘤内血管生成情况相关性。运用独立样本t检验分析淋巴结及远处转移阳性组与阴性组灌注参数之间差异。P<0.05表明差异具有统计学意义。结果肿瘤平均长度(5.93±2.35)cm。37例标本共取材97处(平均每例2.6处),以患者为单位计算肿瘤内微血管密度(MVD)平均值。37例患者Ⅰ期3例,Ⅱ期15例,Ⅲ期11例,Ⅳ期8例。全肿瘤灌注参数血流量(BF)、TTP与肿瘤TNM分期存在相关性(r=-0.673,P<0.001;r=0.644,P<0.001)。全肿瘤灌注参数血流量(BF)、血容量(BV)、达峰时间(TTP)与肿瘤内MVD均无明显相关性(r=0.201,P=0.233;r=0.295,P=0.076;r=-0.178,P=0.292)。淋巴结及远处转移阳性组与阴性组灌注参数比较,BF、TTP存在明显统计学差异(P=0.045;P=0.002),BV不存在统计学差异(P=0.134)。结论 256层CT结直肠癌全肿瘤灌注与肿瘤TNM分期具有良好相关性,在一定程度上可以反映肿瘤临床病理学特征;但结直肠癌全肿瘤灌注参数与MVD值不具有明显相关性。
Objective To investigate the correlation between total tumor perfusion imaging and tumor stage and tumor angiogenesis in 256-slice spiral CT colorectal cancer. Methods From July 2010 to November 2012, 37 patients with colorectal adenocarcinoma who had been examined by fibro-colonoscopy and confirmed by postoperative pathology [including 23 males and 14 females, aged 64.54 ± 11.66) years of age] were subjected to 256-slice spiral CT whole tumor perfusion analysis. The specimens were taken from multiple layers and immunohistochemically stained with anti-human CD105 (Anti-CD105 / Endoglin) Tissue angiogenesis. Total tumor perfusion parameters and clinicopathological parameters (TNM stage, lymph node and distant metastasis), tumor angiogenesis were analyzed and compared. Spearman correlation test and Pearson correlation test were used to analyze the relationship between the parameters of total tumor perfusion and the TNM stage of tumor and intracranial angiogenesis. Independent sample t-test was used to analyze the difference of perfusion parameters between lymph node and distant metastasis positive group and negative group. P <0.05 indicated that the difference was statistically significant. Results The average tumor length (5.93 ± 2.35) cm. A total of 97 specimens (average 2.6 cases per case) were collected, and the mean value of intracranial microvessel density (MVD) was calculated on a patient-by-patient basis. 37 cases of stage Ⅰ in 3 cases, Ⅱ in 15 cases, Ⅲ in 11 cases, Ⅳ in 8 cases. Total tumor perfusion parameters (BF) and TTP were correlated with tumor TNM stage (r = -0.673, P <0.001; r = 0.644, P <0.001). There was no significant correlation between perfusion parameters of blood flow (BF), blood volume (BV), peak time (TTP) and intraductal MVD (r = 0.201, P = 0.233; r = 0.295, -0.178, P = 0.292). There were significant differences in perfusion parameters between BF and TTP (P = 0.045; P = 0.002), there was no significant difference in BV between patients with lymph node metastasis and those with distant metastasis (P = 0.134). Conclusions There is a good correlation between the whole tumor perfusion of 256-layer CT colorectal cancer and the TNM stage of the tumor, which can reflect the clinicopathological features to a certain extent. However, there is no significant correlation between the perfusion parameters and the MVD value of the colorectal cancer.