乳腺癌多层螺旋CT灌注成像与微血管生成的相关性研究

目的 探讨乳腺癌多层螺旋CT (MSCT)灌注成像(PI)与微血管生成的关系.资料与方法 38例乳腺实质肿瘤患者行PI后,切除肿瘤标本53个,以免疫组化法评价癌(28个)、良性实质肿瘤(25个)、癌旁无浸润腺体(26个)的血管内皮生长因子(VEGF)和微血管密度(MVD).结果 乳腺实质肿瘤的MVD与VEGF呈正相关(r=0.82,P＜ 0.05),且时间-密度曲线(TDC)为流出型和平台型的MVD高于流入型和平坦型(F=6.47,P＜ 0.01),乳腺癌的MVD高于良性实质肿瘤及癌旁正常腺体(t=17.67、15.99,P＜ 0.05).乳腺癌的最大密度投影(MIP)、增强平均值(AV)、血流量(BF)、血容量(BV)、血管表面通透性(PS)、Patlak血容量(PBV)与MVD呈正相关(r=0.44、0.46、0.50、0.49、0.52、0.47,P＜0.05).结论 MSCT PI是一种可以较好地反映乳腺癌的血管生成情况的无创性检查方法,对乳腺癌的诊断、鉴别诊断、活检定位有重要价值.

Study on Relation between MSCT Perfusion Imaging and Angiogenesis in Breast Cancer

Purpose To investigate the relationship between multi-slice spiral computed tomography(MSCT) perfusion imaging(PI) and tumor angiogenesis as well as vascular endothelial growth factor(VEGF) expression in patients with breast tumors.Materials and Methods MSCT PI scanning was performed in 38 patients with breast tumors.All patients underwent surgical resection.Immunohistochemical findings of microvessel density(MVD) measurement and VEGF expression were evaluated in 28 breast cancers,26 paracarcinoma breast tissues and 25 benign breast tumors.The means of MSCT perfusion parameter values and VEGF,MVD were used to evaluate the correlation.Results In breast tumors,MVD was positively correlated with VEGF(P < 0.05) and the Spearman rank correlation coefficient was 0.82.The means of MVD in outflow-type and platform-type time-density curve were statistically higher than those in inflow-type and flat-type breast tumors(F=6.47,P <0.01).The means of MVD in breast cancer were higher than those of benign breast tumor and paracarcinoma breast tissues(t=17.67,t=15.99,P<0.05).The maximum intensity projection(MIP),average value(AV),blood flow(BF),blood volume(BV),permeability surface(PS) and Patlak blood volume(PBV) of breast cancer had statistically positive relation with MVD(P < 0.05) with the Pearson correlation coefficients of 0.44,0.46,0.50,0.49,0.52,0.47.Conclusion MSCT PI correlates with tumor angiogenesis and reflects MVD measurement and VEGF expression.It provides not only a non-invasive method of quantitative assessment for blood flow patterns of breast tumor but also an applicable diagnostic method for breast cancer,which are helpful to differentiate the breast cancer from benign breast tumor,to guide breast cancer biopsy.