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目的探讨周围型肺癌双源CT灌注成像与肿瘤微血管密度(MVD)、血管内皮生长因子(VEGF)的关系。方法搜集经胸部X线平片或CT平扫发现肺部肿块并行双源CT容积灌注成像,后经病理证实的周围型肺癌30例。男18例,女12例,年龄40~77岁,平均58.01岁。将CT图像传至Siemens工作站进行图像处理。计算靶层面感兴趣区(ROI)的时间-密度曲线(TDC)。通过最大斜率法获得血流量(BF)、血容量(BV)、对比剂的平均通过时间(MTT)、峰值时间(TTP)和表面通透性(PS)等灌注参数及灌注图像。30例病理标本行常规HE染色病理学检查,采用免疫组织化学检测MVD计数和VEGF的表达情况。分析周围型肺癌双源CT灌注参数与MVD、VEGF表达的关系,比较周围型肺癌有无淋巴转移及与MVD、VEGF表达的关系。结果 (1)周围型肺癌的MVD、VEGF与CT灌注参数值BF、BV呈正相关;与MTT之间无相关性,与TTP之间呈负相关,MVD与PS无相关性,VEGF与PS呈正相关。与MVD及VEGF具有相关性的CT灌注参数中以BF的相关性最高。(2)有淋巴结转移组肺癌MVD值高于无淋巴结转移组肺癌(P<0.05);有淋巴结转移组肺癌VEGF高于无淋巴结转移组肺癌(P<0.05)。结论双源CT灌注成像可评价周围型肺癌的肿瘤微血管生成,有助于在活体评价肿瘤血管生成。MVD、VEGF可作为评价周围型肺癌是否发生淋巴结转移的指标。
Objective To investigate the relationship between dual-source CT perfusion imaging and tumor microvessel density (MVD) and vascular endothelial growth factor (VEGF) in peripheral lung cancer. Methods Thirty patients with peripheral lung cancer confirmed by histopathology were enrolled in this study. 18 males and 12 females, aged 40 to 77 years, mean 58.01 years. Transfer CT images to Siemens workstations for image processing. Calculate the time-density curve (TDC) of the ROI of the target slice. The perfusion parameters such as blood flow (BF), blood volume (BV), mean transit time (MTT), peak time (TTP) and surface permeability (PS) were obtained by the maximum slope method. Pathological examination was performed on 30 pathological specimens by routine HE staining. MVD count and expression of VEGF were detected by immunohistochemistry. The relationship between dual-source CT perfusion parameters and the expression of MVD and VEGF in peripheral lung cancer was analyzed. The relationship between lymphatic metastasis and the expression of MVD and VEGF in peripheral lung cancer was analyzed. Results (1) There was a positive correlation between MVD, VEGF and CT perfusion parameters BF, BV in peripheral lung cancer, no correlation with MTT, negative correlation with TTP, MVD with PS, VEGF with PS . Correlation of CT perfusion parameters with MVD and VEGF showed the highest correlation with BF. (2) The MVD of lung cancer with lymph node metastasis was higher than that without lymph node metastasis (P <0.05). The VEGF of lung cancer with lymph node metastasis was higher than that without lymph node metastasis (P <0.05). Conclusion Dual-source CT perfusion imaging can evaluate the tumor angiogenesis in peripheral lung cancer and help to evaluate tumor angiogenesis in vivo. MVD, VEGF can be used as an indicator of peripheral lymph node metastasis.