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目的探讨肾细胞癌多层螺旋CT(MSCT)灌注扫描参数与肿瘤微血管密度(MVD)、增殖细胞核抗原Ki-67的相关性。资料与方法选择24例经手术病理证实肾细胞癌的患者与15名健康自愿者,行肾区CT平扫后选择经肿瘤的最大层面或正常肾脏选肾门平面为靶平面再行同层动态增强扫描,经过灌注软件处理分析分别获得肾癌组织及双侧肾皮质的血流量(BF)、相对血容比(rBV)、平均通过时间(TTP)、通透性(Pm)及时间密度曲线(TDC图)。24例肿瘤组织切片采用免疫组织化学方法(SP法)检测肾肿瘤中MVD计数和Ki-67的表达。将所获灌注参数与相应免疫组织化学指标进行比较研究。结果(1)各级别肾细胞癌间及肾细胞癌与正常肾皮质BF、rBV、Pm差异均有统计学意义。各级别肾细胞癌间及肾细胞癌与正常肾皮质TTP差异无统计学意义。(2)各级别肾细胞癌间MVD和Ki-67差异均有统计学意义。(3)CT灌注参数中,BF、rBV、Pm与肾细胞癌MVD和Ki-67有明显相关关系;TTP与MVD和Ki-67间无显著相关性。结论MSCT灌注成像能定量检测肾细胞癌血流灌注和血管通透性改变,有助于推测肾细胞癌的术前分级,评价肿瘤血管生成、细胞增殖状态,为术前诊断及治疗提供依据。
Objective To investigate the correlation between perfusion parameters and tumor microvessel density (MVD) and proliferating cell nuclear antigen Ki-67 in renal cell carcinoma by multi-slice spiral CT (MSCT). Materials and Methods Twenty-four patients with pathologically confirmed renal cell carcinoma and 15 healthy volunteers were enrolled in this study. After the plain CT scan of the kidney area, the maximum level of the tumor or the level of the selected kidney in the normal kidney was selected as the target plane, (BF), relative blood volume ratio (rBV), mean transit time (TTP), permeability (Pm), and time-density curve of renal cell carcinoma and bilateral renal cortex were obtained through perfusion software analysis. (TDC chart). Immunohistochemistry (SP method) was used to detect the MVD count and Ki-67 expression in 24 cases of tumor tissue. The perfusion parameters were compared with the corresponding immunohistochemistry. Results (1) There were significant differences in BF, rBV and Pm between renal cell carcinoma and renal cell carcinoma and normal renal cortex at all levels. There was no significant difference in TTP between renal cell carcinoma, renal cell carcinoma and normal renal cortex at all levels. (2) There were significant differences in MVD and Ki-67 between all grades of renal cell carcinoma. (3) BF, rBV and Pm in CT perfusion parameters were significantly correlated with MVD and Ki-67 in renal cell carcinoma; there was no significant correlation between TTP and MVD and Ki-67. Conclusion MSCT perfusion imaging can quantitatively detect the changes of blood perfusion and vascular permeability of renal cell carcinoma, which is helpful to predict the preoperative grade of renal cell carcinoma, evaluate the angiogenesis and proliferation status of the tumor, and provide the basis for preoperative diagnosis and treatment.