Wang Jin Hong, Min Peng Qiu, Wang Pei Jun, Cheng Wei Xia, Zhang Xiu Hui, Wang Yu, Zhao Xiao Hu, Mao Xin Qing
Department of Radiology, Tong Ji Hospital, Tong Ji University, Xin Cun Rd. 389, Shanghai 200065, China.
AJR Am J Roentgenol. 2006 May;186(5):1423-30. doi: 10.2214/AJR.04.1408.
The purpose of our study was to evaluate the correlation between the enhancement parameters of dynamic CT; the carcinoma tissue microvessel density (MVD, a hotspot method to provide a histologic assessment of tumor vascularity); and tumor nuclear grade in renal cell carcinomas.
Twenty-four patients with histologically diagnosed renal cell carcinoma underwent dynamic enhanced CT. Enhancement parameters, slope of the time-density curve, the density difference before and after tissue enhancement (deltaH), tissue blood ratio (TBR), and area under the time-density curve (AR), were calculated for all lesions. Pathology slides corresponding to the CT plane were stained using mouse antihuman CD34 monoclonal antibody and H and E. Fuhrman nuclear grade was used. Vascular hot spots of microvessels were recorded. Spearman's rank correlation was performed to determine the strength of the relationship between enhancement parameters, MVD determinations, and tumor nuclear grade.
MVD with CD34 staining revealed uneven distribution of positively stained vascular endothelial cells in renal cell carcinoma lesions. Heterogeneous distribution of contrast enhancement was seen among and within individual tumors. The tumors appeared as uneven patterns on time-density curves of renal cell carcinoma lesions. Enhancement parameters of H (median, 21.0 H; range, 2.2-105.8 H), TBR (median, 39%; range, 10.7-154.7%), AR (median, 1.58 H x sec; range, 0.23-3.67 H x sec), and slope (median, 2.76; range, 0.53-6.76) varied greatly. Renal cell carcinoma tissue MVD significantly correlated with all enhancement parameters of dynamic CT. The correlation coefficients (r) were 0.62, 0.54, 0.55, and 0.44, respectively, for delta H, slope, TBR, and AR (p < 0.0 5). All enhancement parameters did not significantly correlate with tumor nuclear grade. They were not predictive of nuclear grade.
Enhancement parameters of dynamic CT may be suited to evaluate tumor vascularity in vivo. Dynamic enhanced CT images may reflect the heterogeneity of tumor angiogenesis on the basis of the correlation between enhancement parameters and MVD of renal cell carcinoma.
本研究旨在评估动态CT增强参数、癌组织微血管密度（MVD，一种用于提供肿瘤血管生成组织学评估的热点方法）与肾细胞癌肿瘤核分级之间的相关性。
24例经组织学诊断为肾细胞癌的患者接受了动态增强CT检查。计算所有病灶的增强参数，即时间-密度曲线斜率、组织增强前后的密度差（deltaH）、组织血容量比（TBR）和时间-密度曲线下面积（AR）。对与CT平面相对应的病理切片使用小鼠抗人CD34单克隆抗体以及苏木精和伊红进行染色。采用Fuhrman核分级。记录微血管的血管热点。进行Spearman等级相关性分析以确定增强参数、MVD测定值与肿瘤核分级之间关系的强度。
CD34染色的MVD显示肾细胞癌病灶中血管内皮细胞阳性染色分布不均。在单个肿瘤之间以及肿瘤内部均可见对比增强的异质性分布。肿瘤在肾细胞癌病灶的时间-密度曲线上呈现出不均匀的模式。H（中位数为21.0 H；范围为2.2 - 105.8 H）、TBR（中位数为39%；范围为10.7 - 154.7%）、AR（中位数为1.58 H×秒；范围为0.23 - 3.67 H×秒）和斜率（中位数为2.76；范围为0.53 - 6.76）的增强参数变化很大。肾细胞癌组织MVD与动态CT的所有增强参数均显著相关。deltaH、斜率、TBR和AR的相关系数（r）分别为0.62、0.54、0.55和0.44（p < 0.05）。所有增强参数与肿瘤核分级均无显著相关性。它们不能预测核分级。
动态CT增强参数可能适合于在体内评估肿瘤血管生成。基于增强参数与肾细胞癌MVD之间的相关性，动态增强CT图像可能反映肿瘤血管生成的异质性。
