骨肉瘤CT灌注成像与血管生成的关系*

目的:探讨64排螺旋CT灌注成像（computed tomography perfusion imaging，CTPI）参数与骨肉瘤血管生成之间的关系。方法:选取2007年9 月至2009年6 月南京军区南京总医院26例经病理证实为骨肉瘤的患者，治疗前均行CTPI检查，从而获得骨肉瘤患者肿瘤及正常肌肉组织的血流量（blood flow，BF）、血容量（blood volume，BV）、达峰时间（time to peak ，TTP）、表面通透性（permeability surface，PS）等灌注参数。运用免疫组织化学技术计算治疗前骨肉瘤穿刺标本的微血管密度（microvessel density，MVD）。 对肿瘤组织和肌肉组织灌注参数值进行配对样本t 检验，对灌注参数与MVD运用Pearson相关系数分析，P<0.05为差异有统计学意义。结果:骨肉瘤中的BF、BV、TTP 以及PS值分别为46.6 ± 25.1mL/（100g·min）、61.8 ± 29.5mL/100g、122.9 ± 26.2s 和44.5 ± 14.6mL/（100g·min）。 而正常肌肉组织的BF、BV、TTP 以及PS值分别为5.2 ± 6.6mL/（100g·min）、9.6 ± 7.3mL/100g、115.5 ± 33.1s和17.0 ± 29.3mL/（100g·min），骨肉瘤组的BF、BV和PS高于肌肉组，差异显著并有统计学意义（P=0.000、P=0.000、P=0.000），但TTP的差异无统计学意义，骨肉瘤组的BF、BV以及PS值与MVD的r 值分别为0.83、0.87和0.63，P<0.05，呈明显正相关性，而TTP 与MVD的r 值为-0.02，P=0.93，无显著相关性。结论:CTPI能够很好动态地评价骨肉瘤的血流灌注，并可以反映血管生成及MVD的表达。 

Application of CT Perfusion Imaging in Detection of Tumor Angiogenesis in Osteosarcoma

Objective: To explore the application of 64-slice spiral computed tomography perfusion imaging (CTPI) in evaluating angiogenesis in human osteosarcoma.Methods:Twenty-six patients (18males and 8 females ranging from 9 to 56 years old, with an average of 19 years) with osteosarcoma underwent 64-slice spiral CTPI. We analyzed the correlations of CTPI parameters including blood flow (BF), blood volume (BV), time to peak (TTP), and permeability surface (PS) with the expression of markers of angiogenesis. Statistical analysis was performed with paired-samples t test, and Pearson correlation analysis was employed to investigate the correlations of CTPI parameterts with MVD.Results: Mean BF, BV, TTP, and PS values of osteosarcoma group were 46.6mL/100 g/min ±25.1 (standard deviation), 61.8 mL/100 g ± 29.5, 122 .9 seconds±26.2, and 44.5 mL/100 g/min ±14.6, respectively. Those in the normal muscle group were 5.2 ± 6.6mL/ 100 g/min, 9.6 ± 7.3mL/100 g, 115 .5 ± 33.1 and 17.0 ± 29.3mL/100 g/min, respectively. Osteosarcoma group showed higher BF,BV and PS compared with the normal muscle group (P=0.000 , P=0.000 , and P=0.000 ). However, no significant difference was found in TTP between osteosarcoma tissue and normal adjacent muscle tissue ( P=0.273 ). BF, BV, and PS were positively correlated with MVD (r=0.83, P=0.000 ; r= 0.87, P=0.000 ; and r=0.63, P=0.001 ). No correlation was found between TTP and MVD (r=- 0.02, P=0.93). Conclusion:CTPI is useful for assessing tumor vascularity of osteosarcoma and CTPI parameters are positively correlated with MVD.