肾细胞癌MSCT灌注参数与血管生成、细胞增殖的相关性研究

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。     

双源CT灌注成像在肾细胞癌及肾盂癌诊断中的应用研究

目的分析双源CT(DSCT)肾细胞癌、肾盂癌灌注参数的特点,探讨灌注成像对肾细胞癌及肾盂癌诊断的应用价值。方法回顾性分析经手术病理证实的34例肾细胞癌、15例肾盂癌,行西门子Somatom Sensation 64螺旋CT灌注扫描,应用西门子工作站分别测量肿瘤及对照组正常肾皮质的灌注参数:血流(BF)、血容量(BV)、开始时间(TTS)、达峰时间(TTP)、Patlak血管通透性(PS)、Patlak血容量(PBV)。结果①肾细胞癌BF、BV、PS、PBV低于对侧正常肾皮质(对照组),而TTP则高于对照组肾皮质,二者之间差异有统计学意义(P<0.05);肾细胞癌TTS高于对照组肾皮质,二者之间差异无统计学意义(P>0.05);②肾盂癌BF、BV、PS、PBV低于对侧正常肾皮质(对照组),二者之间差异有统计学意义(P<0.05);肾盂癌TTS高于对照组肾皮质,而TTP则低于对照组肾皮质,二者之间差异无统计学意义(P>0.05);③肾细胞癌BF、BV、PBV高于肾盂癌,二者之间差异有统计学意义(P<0.05);肾细胞癌TTS低于肾盂癌,而TTP、PS则高于肾盂癌,二者之间差异无统计学意义(P>0.05)。结论肾细胞癌、肾盂癌及正常肾皮质DSCT灌注参数不同。DSCT灌注成像在肾脏DSCT灌注成像在肾细胞癌及肾盂癌诊断和鉴别诊断方面有一定的应用价值。     

多层螺旋CT灌注成像技术在诊断肾肿瘤中的临床应用

目的 探讨多层螺旋CT(MSCT)灌注成像在肾肿瘤定性及肾癌临床分期中的应用价值.方法 回顾性分析经病理证实的28 例肾透明细胞癌(分Ⅰ～Ⅳ期)、20例肾错构瘤的多层螺旋CT 灌注成像结果,对肿瘤感兴趣区血流量(BF)、血容量(BV)、平均通过时间(MTT) 与表面通透性(PS)值进行统计学分析,研究其规律性.结果 (1)正常肾皮质BV/A 和BF值明显高于肾透明细胞癌和错构瘤(P＜ 0.01);肾透明细胞癌BV/A和BF值明显高于肾错构瘤(P＜ 0.01);正常肾皮质及肾透明细胞癌PS值明显高于肾错构瘤组(P＜ 0.01).(2)肾透明细胞癌Ⅱ期、Ⅲ～Ⅳ期BV/A值、BF值与PS值明显高于肾透明细胞癌Ⅰ期患者(P＜0.05);肾透明细胞癌Ⅱ期与Ⅲ～Ⅳ期之间相比较,BV/A值与PS值呈上升趋势,前者有统计学意义(P＜0.05),BF值呈下降趋势,比较无统计学意义(P＞0.05).(3)3组之间MTT值比较无统计学差异.结论 肾脏肿瘤MSCT灌注参数具有一定的规律,在肾肿瘤的诊断中有重要的临床应用价值.     

不同分组肾透明细胞癌CT灌注成像的差异

目的 探讨不同分组肾透明细胞癌CT灌注成像的差异.资料与方法 经手术病理证实为肾透明细胞癌的患者40例,术前应用多层螺旋CT(MSCT),选择肿瘤最大层面进行灌注扫描.用去卷积法灌注软件获取肿瘤内多个不同密度感兴趣区(ROI)及双侧肾皮质的血流量(BF)、血容量(BV)、平均通过时间(MTT)、表面通透性(PS)及时间-密度曲线(TDC)图.40例肿瘤按是否可见新生血管、肾盂肾盏受累程度及是否有癌栓分组,统计分析比较不同分组肿瘤间的灌注差异.结果 可见新生血管的肿瘤表面通透性低于未见新生血管肿瘤(P＜0.05);肾盂肾盏受压肿瘤同侧肾脏皮质血流量(C-BF)高于肾盂肾盏无影响肿瘤(P＜0.01);有癌栓肿瘤双侧皮质及最高密度点BV均低于无癌栓肿瘤(P＜0.05).结论 CT灌注成像能从血流动力学和血管功能上为评价肾透明细胞癌进展和预后带来帮助,具有一定的临床应用价值.     

多层螺旋CT灌注成像对肾癌的诊断及鉴别诊断价值

目的:探讨多层螺旋CT(MSCT)灌注成像对肾癌的诊断及鉴别诊断价值。方法:搜集经病理或临床证实的肾细胞癌患者39例,肾错构瘤2例,肾囊肿11例,肾周感染性病变2例,双肾正常者32例,均行MSCT肾脏灌注扫描。通过后处理软件分析所得灌注参数血流量(BF)、血容量(BV)、表面通透性(PS)和平均通过时间(MTT)。结果:正常人两侧肾脏皮质或髓质的BF、BV、MTT、PS无显著性差异。肾癌与正常肾皮质BF、BV、MTT、PS均有显著性意义。而肾癌的BF、BV、PS值低于正常肾皮质,MTT高于正常肾皮质。并且BF值显著高于肾错构瘤、肾囊肿及肾周感染性病变等的BF值。结论:MSCT肾脏灌注成像实现了,肾脏血流的定量研究,对肾肿瘤定性诊断和鉴别诊断方面具有一定的临床应用价值。     

肾癌和肾盂癌MSCT灌注成像及与分子病理学的相关性探讨

目的:运用多层螺旋CT(MSCT)获取肾癌和肾盂癌的灌注图像,并与其分子病理学特征相对照,探讨MSCT灌注成像在肾癌和肾盂癌诊断和鉴别诊断中的临床应用价值。方法:对53例疑有肾肿瘤的患者行MSCT灌注扫描,获得伪彩色的血流灌注参数图,包括血流量(BF)、血容量(BV)、表面通透性(PS)及平均通过时间(MTT)图。在瘤体及瘤旁正常肾皮质选取感兴趣区并记录相应的各项参数值。所有患者均经手术病理证实。53例中肾癌47例,肾盂癌6例。采用免疫组化方法(SP法)检测肾肿瘤中血管内皮生长因子(VEGF)的表达及微血管密度(MVD)。结果:肾细胞癌的BF、BV和PS值均明显低于正常肾皮质,且Ⅲ级肾癌与Ⅰ、Ⅱ级相比,其BF、BV和PS值明显增高。肾盂癌的各项灌注参数值明显低于肾癌。肾癌的BF、BV、PS值与其VEGF平均光密度值呈正相关(P<0.05),MTT值与VEGF平均光密度值呈负相关(P<0.05)。肾癌的MVD值与VEGF值呈正相关(P<0.05)。结论:MSCT灌注成像能定量评价肿瘤血管生成、血流灌注及血管通透性改变,有助于肾细胞癌的术前分级,并在肾癌和肾盂癌的定性诊断和鉴别诊断方面有一定临床应用价值。     

肺孤立性病灶16层螺旋CT首过期灌注成像与血管生成的相关研究

目的 应用16层螺旋CT灌注成像(CTPI)技术,探讨肺孤立性病灶各灌注参数与病灶的微血管密度(MVD)、血管内皮细胞生长因子(VEGF)的相关性. 资料与方法对52例肺孤立性病灶行16层螺旋CT首过期灌注成像,利用Body-perfusion软件进行后处理,获得感兴趣区的血流量(BF)、相对血容量(rBV)、毛细血管渗透性(Pm)、达峰时间(TTP)等灌注参数.其中39例手术患者的组织标本采用免疫组织化学染色后行MVD计数和检测VEGF表达.结果 恶性组和炎性组的BF、rBV、Pm等参数均高于良性组,差异有统计学意义(P均<0.05);恶性组和炎性组仅Pm差异有统计学意义(P<0.05).良性组的TTP略高于恶性组和炎性组,但各组间差异无统计学意义(P>0.05).恶性组和炎性组的MVD、VEGF表达强度均高于良性组,差异有统计学意义(P均<0.05);但恶性组和炎性组之间MVD、VEGF表达强度的差异无统计学意义(P>0.05).除TTP外,恶性组、炎性组和良性组的BF、rBV、Pm参数值与MVD、VEGF呈正相关(P均<0.05),其中以BF与MVD、VEGF和Pm与MVD、VEGF的相关性最高.结论 肺孤立性病灶的CTPI参数与其血管生成有良好相关性,能定量地反映其血管生成情况,有助于对良恶性病灶的鉴别诊断.     

肾透明细胞癌CT灌注成像特点的研究

目的:探讨肾透明细胞癌灌注成像的特点及临床应用价值。方法:37例经过手术病理证实的肾透明细胞癌患者(肿瘤生长部位均靠近肾门附近),术前均选择近肾门层面进行动态增强扫描,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)、血容量(BV)、平均通过时间(MTT)、组织通透性(PS)及时间密度曲线(TDC图)。结果:肾透明细胞癌肿瘤最高密度点血供丰富,但血流量较对侧正常皮质仍较低;肿瘤平均灌注较两侧皮质均低;肿瘤同侧肾脏皮质灌注较对侧低;肿瘤内不同密度点灌注特性不同;不同分级的肿瘤对静脉血流有不同的影响。结论:肾透明细胞癌CT灌注成像具有一定的特点,对其诊断及肾血流的评估具有一定的价值。     

放射性肺炎CT灌注成像的临床研究

目的 采用CT灌注成像(CTPI)技术,探求放射性肺炎(RP)形成的CTPI特点,为预测RP提供依据。方法 对37例胸部肿瘤患者照射前后不同时期行64排螺旋CT灌注成像扫描,得到肺组织感兴趣区(ROI)内各灌注参数值,即血流量(BF)、血容量(BV)、峰值时间(TTP)、表面通透性(PS)、平均通过时间(MTT),进而计算出各灌注参数相对值(rBF、rBV、rTTP、rPS、rMTT)。结果 放疗前,肺癌及其他胸部肿瘤患者的非瘤周肺组织灌注值BF、BV、TTP及MTT均无差异,与性别无关(t值分别为0.643、1.541、0.470及1.199,P>0.05),与左右肺也无关(t值分别为0.857、0.346、0.470及1.656,P>0.05);放疗后,rBF、rBV、rPS均上升者(F值分别为5.552、8.495及14.951,P均<0.05)将发生RP,仅rBF上升者(F=9.146,P<0.05)不发生RP。结论 CTPI可用于肺组织灌注的研究,能反映照射后肺组织灌注的变化规律;rBF、rBV、rPS是预测RP的关键参数。     

早期肝硬化肾脏MSCT灌注成像的研究

目的 探讨多层螺旋CT(MSCT)灌注扫描评价肾脏血流灌注的方法和价值,研究早期肝硬化时肾脏血流灌注的变化规律.资料与方法 对19例经B超、CT、血生化检验、肝穿刺等确诊为早期肝硬化患者(早期肝硬化组)及17名体检者(正常组)行MSCT灌注扫描,描出其时间-密度曲线(TDC),测量并对比血流量(BF)、血容量(BV)、平均通过时间(MTI)和对比剂峰值时间(TTP)等灌注参数. 结果各病例CT灌注的TDC合乎数据分析要求,正常组的左肾皮质TDC呈迅速上升阶段、峰值、迅速下降阶段和相对缓慢下降或近似平衡期阶段,左肾皮质平均峰值达148.70 HU,到达峰值时间平均为10.53 s.左肾皮质BF为(367.77±39.50)ml·min-1·100 g-1,BV为(21.91±9.82)ml/100g,M1Tr为(3.91±0.72)s,TPP为(10.53±3.98)s.早期肝硬化组的左肾皮质TDC形态与正常组比较无明显改变,但TDC上升速度相对缓慢,波峰高度有所下降,早期肝硬化组皮质和髓质的BF值均低于正常组,其中皮质的BF下降明显,与正常组间差异有统计学意义(P<0.05);而髓质的BF下降不明显,与正常组间差异无统计学意义(P>0.05);早期肝硬化组皮质和髓质的BV与正常组对比略有下降,两组间差异均无统计学意义(P>O.05);与正常组对比,早期肝硬化组皮质、髓质的MTT和TPP略有延长,但两组间差异均无统计学意义(P>0.05).结论 MSCT可正确评价肾组织血流灌注变化,MSCT灌注扫描能反映早期肝硬化时肾脏的血液动力学及血流灌注的改变特点,能为临床提供早期肾损害信息,对临床的治疗有重要价值.     

Synchronous ipsilateral renal cell and transitional cell carcinoma

The coexistence of multiple and synchronous primary neoplasms in the genitourinary system has only rarely been described in the literature. We present the case of a 78-year-old man with haematuria as the initial presentation, finally proven to be transitional cell carcinoma (TCC) combined with renal cell carcinoma (RCC). Intravenous urography (IVU), CT and arterial angiography studies revealed a space-occupying nodule at the right upper renal pelvicalyces showing mild enhancement with contrast medium. Another strong contrast medium enhancing exophytic tumour was found at the lower pole of kidney; there were hypodense foci and calcified components in this lesion. A right nephroureterectomy was performed. Pathological diagnosis was a papillary TCC and a clear cell type RCC. This is a rare case of combined renal malignancies diagnosed by imaging.     

肾透明细胞癌与肾乳头状癌、嫌色细胞癌MRI表现的对照研究

目的 探讨MR动态增强扫描对肾癌亚型的鉴别诊断价值.方法 搜集77例经病理证实的肾癌患者资料,其中透明细胞癌(CCRCC)55例,乳头状癌(PRCC)14例,嫌色细胞癌(CRCC)8例,回顾性分析各亚型肿瘤患者MR平扫及动态增强扫描表现并与病理对照,根据肿瘤及肾皮质增强前后的皮质期、实质期及延迟期信号变化,分别进行百分比测量、肿瘤-肾皮质增强指数计算,并采用单因素方差分析和LSD法进行比较.结果 CRCC多数信号均匀(7/8);CCRCC及PRCC多数信号不均(分别为51/55和13/14)、常见坏死(36/55和7/14),PRCC最常见出血(9/14)及囊变(9/14).动态增强各期CCRCC强化程度最高,强化模式呈"快进快退",CRCC轻至中度强化,PRCC强化最轻,两者均呈渐进性延迟强化.CCRCC、PRCC及CRCC皮质期信号变化分别为(296.15±60.27)%、(79.70±18.84)%和(119.56±40.76)%,实质期分别为(236.33±58.31)%、(122.81±27.35)%和(163.06±33.91)%,延迟期分别为(216.83±46.72)%、(117.55±20.63)%和(179.72±32.89)%;三者皮质期的肿瘤-皮质增强指数分别为1.26±0.34、0.33±0.12及0.54±0.10,实质期分别为0.92±0.23、0.41±0.23及0.62±0.15,延迟期分别为0.76±0.14、0.35±0.11及0.69±0.12,各亚型增强各期的信号变化(F值分别为940.931、124.515、38.194,P值均＜0.01)、肿瘤-皮质增强指数(F值分别为798.625、78.308、73.699,P值均＜0.01)差异均有统计学意义.3种亚型的MRI表现与病理学所见基本相符.结论 CCRCC、PRCC及CRCC的MRI动态增强有一定特征性的表现,与其病理特点密切相关,在肾癌亚型的鉴别诊断上有着较高的临床应用价值.

Abstract：

Objective To investigate the differential diagnostic features of subtypes of renal cell carcinoma(RCC) using dynamic contrast-enhanced MRI(DCE-MRI).Methods The MRI appearances of 77 RCCs, including 55 clear cell RCCs(CCRCC),14 papillary RCCs(PRCC) and 8 chromophobe RCCs(CRCC), were retrospectively analyzed and compared with findings of pathology. DCE-MRI was conducted in each case after intravenous administration of contrast agent. Region of interest measurements (cortical, nephrographic and delayed Phases) of signals within tumor and uninvolved renal cortex were used to calculate percentage signal intensity change and tumor-to-cortex enhancement index, and the data was analyzed by AVONA and t test. Results On unenhanced and enhanced MRI, most CRCCs showed homogeneous signal(7/8). CCRCC and PRCC often show inhomogenous signal with necrosis(36/55, 7/14). Hemorrhage and cystic degeneration were often found in PRCC (9/14). On the cortical, nephrographic and delayed phase images, CCRCCs showed greater signal intensity change[(296.15±60.27)%, (236.33±58.31)% and (216.83±46.72)%,respectively than PRCCs (79.70±18.84)%, (122.81±27.35)% and (117.55±20.63)%, respectively], and CRCCs showed intermediate change [(119.56±40.76)%, (163.06±33.91)% and (179.72±32.89)%, respectively].A phenomenon of quick staining and quick fainting was observed in CCRCCs. Both of CRCCs and PRCCs showed delayed enhancement. The tumor-to-cortex enhancement index at the cortical, nephrographic and delayed phases was highest for CCRCCs (1.26±0.34, 0.92±0.23 and 0.76±0.14, respectively), lowest for PRCCs (0.33±0.12, 0.41±0.23 and 0.35±0.11, respectively), and intermediate for CRCCs (0.54±0.10, 0.62±0.15 and 0.69±0.12, respectively,P＜0.01). The degree of enhancement was significantly different among the 3 subtypes at the every contrast enhanced phase (F=940.931, 124.515 and 38.194, P＜0.01), so was the tumor-to-cortex enhancement index(F=798.625,78.308 and 73.699, P＜0.01). There was a good consistency between MR appearances of the 3 RCC subtypes and pathological characteristics. Conclusion DCE-MRI could distinctly show imaging features of CCRCC, PRCC and CRCC, which were related to their pathological characteristics, and these features were helpful in predicting a specific subtype of RCC.     

透明细胞乳头状肾细胞癌的影像学表现

目的探讨透明细胞乳头状肾细胞癌(CCPRCC)的影像学表现。方法分析15例CCPRCC患者CT及MRI影像特征,采用独立样本t检验比较肿瘤与肾皮质之间平扫CT值、ADC值差异。结果15例均为单发,边界清晰,大小为(3.1±1.9)cm。13例为实性肿瘤,其中11例伴囊变,2例为囊性肿瘤。4例CT平扫呈等或稍低密度,4例呈稍高密度;6例密度不均匀,1例伴细条状钙化;8例CT值为(38.4±10.6)HU,与肾皮质比较差异无统计学意义(P>0.05)。8例MRI平扫T1WI呈稍低或低信号,3例伴发结节状、灶状高信号;8例T2WI以混杂高信号为主,5例边缘见包膜;7例DWI呈稍高信号;9例肿瘤ADC值(2.22±0.30)×10-3 mm2/s高于肾皮质,两者差异具有统计学意义(P<0.05)。增强扫描13例实性肿瘤中9例呈“快进快出”强化,4例呈持续或渐进性强化;2例囊性肿瘤增强扫描呈囊壁及中心分隔强化。结论CCPRCC好发于中老年人,肿瘤易发生囊变,出血、钙化少见,弥散受限不明显,增强扫描以“快进快出”强化为主,确诊仍需依靠组织病理学。     

Fluorodeoxyglucose cell incorporation as an index of cell proliferation: evaluation of accuracy in cell culture

The use of fluorodeoxyglucose (FDG) and positron emission tomography (PET) is recognized as an accurate tool for the specific diagnosis and staging of cancer. It has also been proposed for the monitoring of anticancer therapy. FDG cell incorporation reflects glycolytic activity whereas inhibition of cell proliferation corresponds to an efficient cancer treatment. The relationship between FDG incorporation and cell proliferation has yet to be demonstrated. Therefore, we aimed to correlate the effects of the toxic agents bleomycin and unlabelled meta-iodobenzylguanidine (mIBG) on cellular metabolism and proliferation. We determined the in vitro metabolic and cytotoxic effects of bleomycin and mIBG by measuring the incorporation of fluorine-18 FDG (%U_FDG) and hydrogen-3 thymidine (%U_THY) in cells of the human premonocytic line U937 in the presence of increasing concentrations of these agents. Proliferation rate of these cells was studied by means of limiting dilution analysis. %U_THY appeared more sensitive to bleomycin or mIBG-mediated cell injury than %U_FDG. After 1 h of exposure to 0.5 M bleomycin, %U_THY was significantly reduced to 62.0% ± 10.4% of control value whereas %U_FDG remained unchanged (91.6% ± 5.3%). Similar results were obtained after 1 h of exposure to increasing concentrations of mIBG (1 M to 1 mM). After 20 h of exposure to bleomycin, %U_THY and %U_FDG were significantly reduced as a function of concentration. After 20 h of exposure to mIBG, a transient increase in %U_FDG up to 149.3% ± 11.2% with 50 M mIBG was further followed by a reduction to 20.1% ± 6.7% with 0.5 mM (P < 0.001). The clonogenic efficiency was reduced as a function of bleomycin (ANOVA, n=255, P) or mIBG concentration (n=80, P) and nearly abolished with 0.1 M bleomycin or 0.1 mM mIBG. In conclusion, %U_THY appears to be a more sensitive index of cytotoxicity in vitro and more accurately relates to cell proliferation than %U_FDG. Correspondence to: D.O. Slosman, Nuclear Medicine Division, Geneva University Hospital, CH-1211 Geneva 14, Switzerland     

一种改进的用于测定细胞周期的细胞制备方法

目的 :减少细胞的聚集数量 ,提高测试效率和结果的准确性。方法 :在用酒精固定细胞时分别加入终浓度为 0 % ,1.5 % ,3% ,6 %和 12 %的小牛血清 ,置 - 2 0℃分别固定细胞 1d ,3d和 7d。比较了不同浓度的血清和保存不同时间粘连细胞的数量及对细胞周期分析结果的影响。结果 :加入血清可明显减轻细胞的粘连 ,减少了细胞的聚集数量 ,尤以 3%小牛血清组最佳。样品可不必过滤 ,在上机测试时 ,进样针不堵塞 ,上样速度快 ,细胞周期分析更准确。随着保存时间的延长 ,聚集细胞的数量有增加的趋势。结论 :在制备用于测定细胞周期的样品时 ,固定细胞的过程中加入终浓度为 3%的小牛血清是一种简单的、能有效地保护细胞膜使细胞不易粘连的技术措施 ,且固定细胞的时间不宜超过 7d。     

Clear cell chondrosarcoma

The clinical, radiologic, and histopathologic features of three cases of clear cell chondrosarcoma are described. On radiographs, this rather benign-appearing tumor resembles a chondroblastoma when it occurs at the end of a long bone, and may occasionally show a calcified matrix. However, it has distinctive tumor cells with a centrally placed vesicular nucleus surrounded by clear cytoplasm. The lesion has a low-grade malignancy and is amenable to en bloc surgical resection, which results in a much better prognosis than that of conventional chondrosarcoma.