Jiang Nan-Chuan, Han Ping, Zhou Cheng-Kai, Zheng Jin-Long, Shi He-Shui, Xiao Jie
Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China.
Ai Zheng. 2009 Feb;28(2):164-9. Epub 2009 Feb 15.
Differential diagnosis of malignant solitary pulmonary nodules (SPNs) from benign ones is difficult based on imaging manifestations. This study was to assess dynamic enhancement patterns of SPNs detected with multi-detector row computed tomography (MDCT), correlate SPN manifestations of MDCT to the expression of vascular endothelial growth factor (VEGF) and microvessel density (MVD), thus to explore the potential value of MDCT imaging in the diagnosis of SPNs.
Fifty pathologically and one clinically confirmed patients with SPNs (diameter <or= 4 cm) undergoing MDCT plain and dynamic enhancement scans were enrolled in the study. The entire lung was scanned at 15 s after injection of the contrast agent; dynamic enhancement scans of SPNs were performed at 45 s, 75 s, 135 s, 195 s and 255 s after contrast injection. The enhancement patterns, pre-, peak and net enhancement of SPNs were assessed. Pearson correlation coefficient was used to correlate peak enhancement, net enhancement to the expression of VEGF and MVD.
The peak and net enhancements were significantly higher in malignant nodules (mean attenuation, 69.9 Hu and 32.9 Hu) than in benign nodules (mean attenuation, 51.7 Hu and 17.2 Hu) (p < 0.001). When net enhancement of 20 Hu was set as the cutoff value to differentiate malignant nodules from benign ones, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 96.43%, 69.57%, 79.41%, 94.12% and 84.31%, respectively. The enhancement patterns between malignant and benign SPNs were significantly different. Homogeneous enhancement or heterogeneous tending to homogeneous enhancement appeared mostly in malignant nodules (78.57%). Benign nodules were almost not enhanced (52.17%). Expressions of MVD and VEGF were significantly different between malignant and benign SPNs. VEGF was positively correlated to the peak enhancement value (r = 0.505, p = 0.014) and the net enhancement value (r = 0.565, p = 0.005). Similarly, MVD was also positively correlated to the peak enhancement value (r = 0.819, p < 0.001) and the net enhancement value (r = 0.845, p < 0.001).
Net enhancement value is an important indicator for differential diagnosis of malignant and benign SPNs. Characteristic enhancement patterns are different between malignant and benign SPNs. Peak enhancement and net enhancement values are positively correlated with VEGF and MVD, both of which reflect the extent of angiogenesis in SPNs to some extent.
基于影像学表现鉴别恶性孤立性肺结节（SPN）与良性结节存在困难。本研究旨在评估多排螺旋计算机断层扫描（MDCT）检测到的SPN的动态增强模式，将MDCT的SPN表现与血管内皮生长因子（VEGF）表达及微血管密度（MVD）相关联，从而探讨MDCT成像在SPN诊断中的潜在价值。
50例经病理及1例经临床确诊的SPN（直径≤4 cm）患者接受MDCT平扫及动态增强扫描纳入本研究。注射对比剂后15 s对全肺进行扫描；对比剂注射后45 s、75 s、135 s、195 s和255 s对SPN进行动态增强扫描。评估SPN的增强模式、增强前、峰值及净增强值。采用Pearson相关系数将峰值增强、净增强与VEGF及MVD的表达相关联。
恶性结节的峰值及净增强值（平均衰减值分别为69.9 Hu和32.9 Hu）显著高于良性结节（平均衰减值分别为51.7 Hu和17.2 Hu）（p<0.001）。以20 Hu的净增强值作为区分恶性与良性结节的临界值时，敏感性、特异性、阳性预测值、阴性预测值及准确性分别为96.43%、69.57%、79.41%、94.12%和84.31%。恶性与良性SPN的增强模式存在显著差异。均匀增强或不均匀且趋于均匀增强多见于恶性结节（78.57%）。良性结节几乎无增强（52.17%）。恶性与良性SPN之间MVD及VEGF的表达存在显著差异。VEGF与峰值增强值（r = 0.505，p = 0.014）及净增强值（r = 0.565，p = 0.005）呈正相关。同样，MVD也与峰值增强值（r = 0.819，p<0.001）及净增强值（r = 0.845，p<0.001）呈正相关。
净增强值是鉴别恶性与良性SPN的重要指标。恶性与良性SPN的特征性增强模式不同。峰值增强及净增强值与VEGF及MVD呈正相关，二者在一定程度上均反映了SPN中的血管生成程度。
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