多层螺旋CT灌注成像在肾肿瘤中的应用及与分子病理学的相关性

目的]探讨多层螺旋CT（MSCT）灌注成像在肾肿瘤诊断中的价值。方法]59例肾肿瘤行MSCT灌注扫描．应用perfusion2软件包计算血流量（BF）、血容量（BV）、表面通透性fPS）及平均通过时间（MTT）．同时检测肾肿瘤及肿瘤旁正常组织中血管内皮生长因子（VEGF）的表达及微血管密度（MVD），结果]59例肾肿瘤术后病理证实为。肾癌48例，肾盂癌6例，肾血管平滑肌脂肪瘤5例。在不同级别的肾细胞癌中．其灌注参数BF、BV和PS均明显低于正常肾皮质（P〈0．01），且高级别的肾癌灌注参数BF、BV和PS均明显高于低级别的肾癌（P〈0．01）。肾血管平滑肌脂肪瘤和肾盂癌的灌注值均明显低于肾癌，有显著性差异（P〈0．01）。肾癌的BF、BV、PS值与肿瘤的VEGF表达呈显著正相关（P〈0．01），MTT、值与VEGF表达呈显著负相关（P〈0．01）。结论]MSCT灌注成像能定量评价肿瘤血管生成，血管灌注及血管通透性改变，有助于肾细胞癌的术前分级．并在肾肿瘤的鉴别诊断方面具有一定的临床应用价值。

Application of Multi-slice Helical Computed Tomography (MSCT) Perfusion to Renal Tumors and Its Relationship with Molecular Pathology

Purpose]To investigate the value of multi-slice helical computed tomography（MSCT） perfusion in diagnosis for renal tumor. Methods] Fifty-nine cases with newly diagnosed renal tumor underwent perfusion imaging with MSCT. Renal blood volume（BV）, blood flow（BF）, permeability surface（PS） and mean transit time（MTT） were analyzed using perfusion 2 software. Expression of vascular endothelial growth factor （VEGF） and microvascular density（MVD） in renal tumor tissue and tumor surrounding tissue were examined. Results] Fifty-nine cases with renal tumor were pathologically proved, including 48 cases with renal cell carcinoma （RCC）, 6 cases with renal pelvic carcinoma （RPC）, and 5 cases with renal agiomyolipoma （RAML）. The mean BF, BV and PS in different grade of RCC were lower than those of normal renal cortex（P〈0.01）, and those in high grade RCC were significantly higher than those in low grade RCC（P〈0.01）. The perfusion parameters in RPC and RAMI, were significantly lower than those in RCC （P〈0.01）. The mean BF, BV and PS of RCC had significant positive correlation with expression of VEGF, and a significant negative correlation was observed between the mean MTT and expression of VEGF. Conclusion] MSCT perfusion imaging is a functional imaging technique that is capable of quantitative assessment to tumor angiogenesis, blood perfusion and vascular permeability, and it also can provide in- formation for staging of RCC. MSCT perfusion imaging is valuable for differential diagnosis of renal tumor.