头颈部肿瘤CT灌注成像与微血管密度(MVD)的相关性研究

 目的 研究头颈部肿瘤CT灌注成像和微血管密度(microvessel density,MVD)的相关性,探讨其在评价肿瘤血管丰富程度及鉴别良、恶性肿瘤中的应用价值。方法 将41例头颈部肿瘤分成3组:A组16例,良性乏血供肿瘤;B组13例,良性富血供肿瘤;C组12例,恶性肿瘤。术前对所有肿瘤行CT灌注检查,用后处理软件绘制时间 密度曲线(time density curve,TDC),并计算感兴趣区的最大密度投影(maximum intensity projection,MIP)、血容量(blood volume,BV)、血流量(blood flow,BF)、平均通过时间(mean transit time,MTT)和毛细血管通透性(capillary permeability,CP)等参数。同时切取与CT灌注相同层面的组织切片,行CD34抗体免疫组织化学染色,观察分析各CT灌注成像在3组肿瘤之间表现的差异及其与MVD的相关性。 结果 头颈部肿瘤CT灌注成像TDC显示,良性肿瘤(A组+B组)出现I型TDC的频率明显高于恶性肿瘤(C组)(P=0.003),恶性肿瘤中以Ⅱ型和Ⅲ型TDC为主。B组和C组的MIP、BV及BF均比A组明显高(P<0.01)。MVD在3组肿瘤之间差异无统计学意义(P>0.05)。Pearson相关性分析表明在3组肿瘤中MVD与MIP、BV均呈正相关(P<0.05,r值分别为0.41,0.352)。结论 CT灌注成像的TDC形态、MIP和BV等可间接反映头颈部肿瘤血管生成情况,结合MVD有助于鉴别良性乏血供肿瘤、良性富血供肿瘤及恶性肿瘤。

Head and neck neoplasms:correlation of CT perfusion with microvessel density (MVD)

Objective  To evaluate the correlation between CT perfusion (CTP) and microvessel density (MVD) in head and neck neoplasms (HNNs),and to assess its value in the differential diagnosis of benign HNNs from malignant ones.Methods  Forty-one HNNs proved by pathology underwent CTP before the operation.All lesions were divided into three groups:group A (sixteen cases),benign hypovascular lesions;group B (thirteen cases),benign hypervascular lesions;group C (twelve cases),malignant lesions.Time density curve (TDC) and CTP parameters including maximum intensity projection (MIP),blood volume (BV),blood flow (BF),mean transit time (MTT),and capillary permeability (CP) were analyzed respectively.Tissue slices from the same level as CT perfusion were used for anti-CD34 immunohistochemical staining and MVD counts.The relation between perfusion measurements and MVD were analyzed.Results  TDC could be classified into three types.TDC of type I was more frequently found in benign lesions (group A and B) than in malignant lesions (group C) (P=0.003),while type II and type III were mainly found in group C.MIP,BV and BF were all significantly higher in both group B and C than group A (all P<0.01).There was no statistically significant difference in MVD among the three groups (P>0.05).Pearson correlation showed a positive correlation between MVD and MIP,BV respectively among the three groups (all P<0.05,r=0.41,0.352).Conclusions  TDC,MIP and BV of CTP could reflect angiogenesis of HNNs indirectly.CTP combined with MVD could help differentiating malignant from benign HNNs,as well as benign hypovascular from hypervascular ones.