子宫平滑肌瘤MRI定量灌注参数与肿瘤微血管密度、VEGF及Ki-67的相关性研究

目的 探讨动态增强磁共振成像(DCE-MRI)定量灌注参数在鉴别子宫肌瘤病理亚型中的价值,并分析其与微血管密度(MVD)、血管内皮生长因子(VEGF)、Ki-67等免疫组化指标的相关性。 方法 选取2015年10月-2016年9月于绍兴市人民医院行子宫肌瘤切除术的63例患者,根据病理亚型分为普通组(29例)、富细胞组(12例)、变性组(22例),术前均行DCE-MRI增强扫描,运用Extended Tofts双室模型拟合计算出定量灌注参数(Ktrans、K_ep、V_e、V_p)及灌注参数彩图;免疫组化方法测定组织标本的MVD、VEGF、Ki-67的表达;比较分析3组子宫肌瘤定量灌注参数、免疫组化分数的组间差异以及两者间的相关性。 结果 3组子宫肌瘤的定量灌注参数指标间存在差异,富细胞组子宫肌瘤Ktrans、K_ep、V_p值高于普通组及变性组(均P<0.05);子宫肌瘤Ktrans、K_ep、V_e、V_p与微血管密度MVD呈不同程度正相关(r分别为0.770、0.524、0.276、0.472;均P<0.05),Ktrans、K_ep、V_p与ki-67正相关(r分别为0.637、0.421、0.439;均P<0.05),Ki-67与MVD亦有相关性(r=0.681,P<0.001),定量灌注参数指标与VEGF之间差异无统计学意义。 结论 DCE-MRI定量灌注参数有助于不同病理亚型子宫肌瘤间的鉴别诊断,且可以作为子宫肌瘤微血管情况及细胞增殖活性的预测因子。 

Correlations between of MRI quantitative perfusion parameters with MVD,VEGF and Ki-67 in uterine fibroids

Objective To investigate the value of dynamic enhanced magnetic resonance imaging (DCE-MRI) quantitative perfusion parameters in differentiate uterine fibroids subtypes and analyze whether there is correlations between the perfusion parameters and micro vascular density (MVD), vascular endothelial growth factor (VEGF), and Ki-67. Methods Sixty-three patients underwent hysteromyoma resection between October, 2015 and September, 2016 were divided pathologically in three groups:classical(29 cases), cellular(12 cases)and degenerative (22 cases). All patients performed DCE-MRI preoperative, double-chamber model Extended-tofts was used to calculate the parameters (Ktrans, K_ep, V_e, V_p) and depict the parameters map. Immune-histochemical methods were used to measure the expression of MVD, VEGF, and Ki-67. The parameters, MVD, VEGF and Ki-67 were compared in the three groups. The correlations between parameters and immune-histochemical fractions were also explored. Results The value of Ktrans, K_ep and Vp were higher in the cellular group than in the classical group and the degenerated group (P<0.05); Ktrans, K_ep, V_e and V_p were positively associated with MVD(r=0.770, r=0.524, r=0.276, r=0.472; P<0.05). Ktrans, K_ep, V_p were positively as sociated with Ki-67(r=0.637, r=0.421, r=0.439; P<0.05). While Ki-67 and MVD also showed apositive correlation (r=0.681, P<0.001), there were no correlation between quantitative perfusion indexes and VEGF. Conclusion Quantitative perfusion parameters derived DCE-MRI contribute to differentiation varies pathological subtypes of uterine fibroids, and these parameters can be used as predictors to evaluate uterine fibroids microvascular and cell proliferative activity.