肾细胞癌多层螺旋CT动态增强定量参数、灌注参数与病理学对照研究
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摘要
第一部分:肾细胞癌MSCT增强定量参数和增强模式对病理亚型诊断研究
目的
评价多层螺旋CT增强定量参数和增强模式对肾细胞癌(RCC)病理分型的诊断价值。
方法
经手术病理证实透明细胞肾细胞癌(CCRCC)32例、乳头状肾细胞癌(PRCC)5例、嫌色细胞肾细胞癌(ChRCC)5例,术前行平扫、皮髓质期(CMP)、实质期(NP)、排泄期(EP)多期CT动态增强扫描。运用标准化校正方法减少心输出量等诸多因素对CT值的影响,根据校正的CT定量参数比较肿瘤强化程度,同时观察肿瘤增强模式。
结果
根据标准化测算结果,在皮质期CCRCC较其他亚型明显增强,有统计学意义(P<0.05);CCRCC和PRCC强化峰值位于皮髓质期,ChRCC则呈延迟强化的特点,强化峰值位于实质期;在皮质期以100Hu为阈值,判断CCRCC与另两种细胞亚型准确性较高。CCRCC和PRCC以不均匀增强、周边增强为主,ChRCC通常呈均匀增强。
结论
CT增强定量参数是区分肾细胞癌亚型的重要指标,与增强模式结合对肾细胞癌亚型鉴别诊断有重要意义。
第二部分: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
探讨肾细胞癌螺旋CT灌注扫描参数与肿瘤微血管密度(MVD)、血管内皮生长因子(VEGF)及增殖细胞核抗原Ki-67的相关性。
方法
选择26例经手术病理证实肾细胞癌病人与15例健康自愿者者,行肾区CT平描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)。26例肿瘤组织切片采用免疫组化方法(SP法)检测肾肿瘤中MVD计数、VEGF的表达及Ki-67的表达。将所获灌注参数与相应免疫组化指标进行比较研究。
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均有显著性差异。各级别肾细胞癌间及肾细胞癌与正常肾皮质TTP无显著性意义。②各级别肾细胞癌间微血管密度和Ki-67差异均有显著性意义;各级别肾细胞癌间血管内皮生长因子差异无显著性意义。③CT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;肾细胞癌VEGF表达与BF有明显相关关系,与其他灌注参数无显著相关性。
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。
Ⅰ. The Study of Quantitative MSCT Enhancement Parameters and Enhancement Pattern for the Differentiation of the Subtypes of Renal Cell Carcinoma
Objective
The purpose of our study was to evaluate quantitative CT enhancement parameters and enhancement pattern of multiphasic multislice spiral CT(MSCT) enhancement patterns to enable lesion of differentiation of the subtypes of renal cell carcinoma (RCC).
Methods
42 cases of RCC proved by surgery and pathology were performed with multiphasic MSCT scanning of unenhanced phase, corticomedullary phase(CMP), nephrographic phase(NP) and excretory phases(EP)before operation. We reviewed CT scans of three subtypes of renal cell carcinoma: 32 conventional (clear cell), 5 papillary RCC and 5 chromophobe RCC. We used a new method to standardize enhancement measurement in lesions on multiphasic CT not being influenced by intrinsic factors like cardiac output. The degree according to standardize enhancement measurement and pattern of enhancement were compared and analyzed.
Results
According to the result of new correction method,conventional renal cell carcinoma showed stronger enhancement than the other subtypes (P<0.05) in the corticomedullary phase.The peak time of CCRCC and PRCC were in corticomedullary phase,which was earlier than that of ChRCC. The cutoff value with the highest accuracy for the differentiation of conventional renal carcinoma from nonconventional renal carcinomas was 100 H in the corticomedullary phase.Most of CCRCC and PRCC tended to show heterogeneous or predominantly peripheral enhancement, whereas ChRCC usually showed homogeneous enhancement.
Conclusion
For the differentiation of the subtypes of renal cell carcinoma, quantitative CT enhancement parameters is the most valuable parameter.The new correction method and enhancement pattern can serve important roles in the identification of the subtype of RCC.
Ⅱ. The Correlation of MSCT Perfusion Parameters with Tumor Angiogenesis and Cell Multiplication in Renal Cell Carcinoma
Objective
To investigate the correlation of MSCT perfusion parameters with tumor microvessel density (MVD),vascular endothelial growth factor (VEGF) and Ki-67 antigen in RCC.
Methods
The study included 26 cases of RCC proven histopathologically and 15 healthy volunteers as control. Target-slice dynamic enhanced scanning was performed by MSCT for all patients. Parameters including blood flow (BF),relative blood value (rBV),time to peak(TTP),permeability (Pm) and time-density curve (TDC) were analyzed using perfusion software. MVD,VEGF and Ki-67 antigen expression were measured with immuno-histology chemistry technique (SP technique) . The results were compared with MSCT perfusion imaging.
Results
①There were significant differences for BF,rBVand Pm between different tumor cell grades,RCC and normal renal cortex. There was no significant association for TTP between different tumor cell grades,RCC and normal renal cortex.②There were significant differences for MVD and Ki-67 antigen between different tumor cell grades.There was no significant association for VEGF between different tumor cell grades.③CT perfusion parameters,including BF,rBV and Pm had significant correlations with MVD and Ki-67 antigen of lesions. TTP had no correlation with MVD and Ki-67 antigen of lesions.There was no correlation between VEGF and perfusion parameters exclude BF.
Conclusion
Blood flow perfusion and permeability of RCC could be quantitatively measured by MSCT perfusion imaging. MSCT perfusion provides useful information for pre-surgical staging,which is a valuable means to assess tumor angiogenesis and cell multiplication,which is significant in the diagnosis and treatment of RCC.
目的
评价多层螺旋CT增强定量参数和增强模式对肾细胞癌(RCC)病理分型的诊断价值。
方法
经手术病理证实透明细胞肾细胞癌(CCRCC)32例、乳头状肾细胞癌(PRCC)5例、嫌色细胞肾细胞癌(ChRCC)5例,术前行平扫、皮髓质期(CMP)、实质期(NP)、排泄期(EP)多期CT动态增强扫描。运用标准化校正方法减少心输出量等诸多因素对CT值的影响,根据校正的CT定量参数比较肿瘤强化程度,同时观察肿瘤增强模式。
结果
根据标准化测算结果,在皮质期CCRCC较其他亚型明显增强,有统计学意义(P<0.05);CCRCC和PRCC强化峰值位于皮髓质期,ChRCC则呈延迟强化的特点,强化峰值位于实质期;在皮质期以100Hu为阈值,判断CCRCC与另两种细胞亚型准确性较高。CCRCC和PRCC以不均匀增强、周边增强为主,ChRCC通常呈均匀增强。
结论
CT增强定量参数是区分肾细胞癌亚型的重要指标,与增强模式结合对肾细胞癌亚型鉴别诊断有重要意义。
第二部分: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
探讨肾细胞癌螺旋CT灌注扫描参数与肿瘤微血管密度(MVD)、血管内皮生长因子(VEGF)及增殖细胞核抗原Ki-67的相关性。
方法
选择26例经手术病理证实肾细胞癌病人与15例健康自愿者者,行肾区CT平描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)。26例肿瘤组织切片采用免疫组化方法(SP法)检测肾肿瘤中MVD计数、VEGF的表达及Ki-67的表达。将所获灌注参数与相应免疫组化指标进行比较研究。
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均有显著性差异。各级别肾细胞癌间及肾细胞癌与正常肾皮质TTP无显著性意义。②各级别肾细胞癌间微血管密度和Ki-67差异均有显著性意义;各级别肾细胞癌间血管内皮生长因子差异无显著性意义。③CT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;肾细胞癌VEGF表达与BF有明显相关关系,与其他灌注参数无显著相关性。
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。
Ⅰ. The Study of Quantitative MSCT Enhancement Parameters and Enhancement Pattern for the Differentiation of the Subtypes of Renal Cell Carcinoma
Objective
The purpose of our study was to evaluate quantitative CT enhancement parameters and enhancement pattern of multiphasic multislice spiral CT(MSCT) enhancement patterns to enable lesion of differentiation of the subtypes of renal cell carcinoma (RCC).
Methods
42 cases of RCC proved by surgery and pathology were performed with multiphasic MSCT scanning of unenhanced phase, corticomedullary phase(CMP), nephrographic phase(NP) and excretory phases(EP)before operation. We reviewed CT scans of three subtypes of renal cell carcinoma: 32 conventional (clear cell), 5 papillary RCC and 5 chromophobe RCC. We used a new method to standardize enhancement measurement in lesions on multiphasic CT not being influenced by intrinsic factors like cardiac output. The degree according to standardize enhancement measurement and pattern of enhancement were compared and analyzed.
Results
According to the result of new correction method,conventional renal cell carcinoma showed stronger enhancement than the other subtypes (P<0.05) in the corticomedullary phase.The peak time of CCRCC and PRCC were in corticomedullary phase,which was earlier than that of ChRCC. The cutoff value with the highest accuracy for the differentiation of conventional renal carcinoma from nonconventional renal carcinomas was 100 H in the corticomedullary phase.Most of CCRCC and PRCC tended to show heterogeneous or predominantly peripheral enhancement, whereas ChRCC usually showed homogeneous enhancement.
Conclusion
For the differentiation of the subtypes of renal cell carcinoma, quantitative CT enhancement parameters is the most valuable parameter.The new correction method and enhancement pattern can serve important roles in the identification of the subtype of RCC.
Ⅱ. The Correlation of MSCT Perfusion Parameters with Tumor Angiogenesis and Cell Multiplication in Renal Cell Carcinoma
Objective
To investigate the correlation of MSCT perfusion parameters with tumor microvessel density (MVD),vascular endothelial growth factor (VEGF) and Ki-67 antigen in RCC.
Methods
The study included 26 cases of RCC proven histopathologically and 15 healthy volunteers as control. Target-slice dynamic enhanced scanning was performed by MSCT for all patients. Parameters including blood flow (BF),relative blood value (rBV),time to peak(TTP),permeability (Pm) and time-density curve (TDC) were analyzed using perfusion software. MVD,VEGF and Ki-67 antigen expression were measured with immuno-histology chemistry technique (SP technique) . The results were compared with MSCT perfusion imaging.
Results
①There were significant differences for BF,rBVand Pm between different tumor cell grades,RCC and normal renal cortex. There was no significant association for TTP between different tumor cell grades,RCC and normal renal cortex.②There were significant differences for MVD and Ki-67 antigen between different tumor cell grades.There was no significant association for VEGF between different tumor cell grades.③CT perfusion parameters,including BF,rBV and Pm had significant correlations with MVD and Ki-67 antigen of lesions. TTP had no correlation with MVD and Ki-67 antigen of lesions.There was no correlation between VEGF and perfusion parameters exclude BF.
Conclusion
Blood flow perfusion and permeability of RCC could be quantitatively measured by MSCT perfusion imaging. MSCT perfusion provides useful information for pre-surgical staging,which is a valuable means to assess tumor angiogenesis and cell multiplication,which is significant in the diagnosis and treatment of RCC.
引文
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10. Martirosian P, Klose U, Mader I, et al. FAIR true-FISP perfusion imaging of the kidneys [J]..Magn Reson Med. 2004 Feb;51(2):353-361.
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12.Vallee JP, Lazeyras F, Khan HG, et al. Absolute renal blood flow quantification by dynamic MRI and Gd-DTPA[J]. Eur Radiol,2000;10(8):1245-1252
13.Anderson H,Yap J T,Wells P,et al.Measurement of Renal Tumour and Normal Tissue Perfusion Using Positron Emission Tomography in a Phase II ClinicalTrial of Razoxane [J].Br J Cancer,2003,89 (2):262-267.
14 . Manka C, Traber F, Gieseke J , et al.Three-dimensional dynamic susceptibility-weighted perfusion MR imaging at 3.0 T: feasibility and contrast agent dose. [J].Radiology,2005,234(3):869-877
15.周长玉,李苏建.磁共振成像在乳腺疾病诊断中的应用[J].医学研究生学报,2004,17(2):178-180.
16.Dalla-Palma L,Panzetta G,Pozzi-Mucelli RS, et al.Dynamic magnetic resonance imaging in the assessment of chronic medical nephropathies with impaired renal function[J].Eur Radiol,2000,10 (2) :280-286.
17.Amin MB,Amin MB, Tamboli P,et al.Prognostic Impact of Histologic Subtyping of Adult Renal Epithelial Neoplasms: an Experience of 405 Case[J ].Am J Surg Pathol ,2002,26 (3):281-291.
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19.Miles KA.Tumor angiogenesis and its relation to contrast enchancement on computed tomogramphy:a review[J] . Eur J Radiol,1999,30(3):198-205.
20.袁庆中 ,田建明,王培军,等.CT灌注成像在肾肿瘤鉴别诊断中的应用价值[J].中国医学影像技术,2005,21(3):436-439.
21.Kim J K,Kim TK,Ahn HJ, et al .Differentiation of subtypes of renal cell carcinoma on helical CT scans [J] . AJR, 2002 ,178 (6):1499-1506.
22.许楠, 华佳, 柴伟明,等.肾透明细胞癌CT 灌注成像特点的研究[J].放射学实践2006,21(5):464-467.
23.王金红,陈卫霞,张秀辉,等. 肾细胞癌螺旋CT 表现与肿瘤血管生成的相关性研究[J].中华放射学杂志,2004,38(8):800-804.
24.袁庆中 ,田建明,王培军,等.CT灌注成像在肾癌预后评估方面的应用价值[J].中国医学影像技术,2004,20(9):1403-1405.
25.Teh HS,Ang Es,WongWC, et al. MR renography using a dynamic gradient-echo sequence and low-dose gadopentetate dimeglumine as an alternative to radionuclide renography[J].AJR,2003(2),181: 441- 450.
26. Huang,-A-J,Lee,-V-S,Rusinek,-H, Functional renal MR imaging[J].Magn Reson Imaging Clin N Am .2004,12(3):469-486.
27.Michaely HJ, Schoenberg SO, Oesingmann N, et al.Renal artery stenosis: functional assessment with dynamic MR perfusion measurements--feasibility study[J]. Radiology. 2006,238(2):586-596.
28.Fenchel,-M;Martirosian,-P;Langanke,-J,et al. Perfusion MR imaging with FAIR true FISP spin labeling in patients with and without renal artery stenosis:initial experience[J]. Radiology,2006,238(3):1013-1021.
29.De Priester JA, den Boer JA, Christiaans MH, et al. Automated quantitative evaluation of diseased and nondiseased renal transplants with MR renography.[J]. J Magn Reson Imaging, 2003, 17(1): 95-103.
30.AssSadowski EA, Fain SB, Alford SK, et al.essment of acute renal transplant rejection with blood oxygen level-dependent MR imaging: initial experience[J]. Radiology. 2005 ,236(3):911-919.