计算机断层扫描灌注成像在肾细胞癌中的应用：与组织病理学血管生成和预后标志物的系统比较。

Computed tomography perfusion imaging of renal cell carcinoma: systematic comparison with histopathological angiogenic and prognostic markers.

机构信息

Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.

出版信息

Invest Radiol. 2013 Apr;48(4):183-91. doi: 10.1097/RLI.0b013e31827c63a3.

DOI:10.1097/RLI.0b013e31827c63a3

PMID:23328912

Abstract

PURPOSE

The aim of this study was to systematically analyze the correlation between computed tomography (CT) perfusion and histopathological angiogenic and prognostic markers in patients with renal cell carcinoma (RCC).

MATERIAL AND METHODS

Fifteen patients (12 men; mean age, 64.5 ± 9.4 years) with RCC underwent contrast-enhanced CT perfusion imaging (scan range, 10 cm; scan time, 40 seconds; dual-source 128-section CT) 1 day before surgery. The procedure for surgical specimen processing was modified to obtain an exact match with CT images. Microvessel density (MVD) was quantified by CD34 staining, and lymphatic vessel density (LVD) was stained with D2-40 antibodies. The CT perfusion values blood flow (BF), blood volume (BV), and flow extraction product (K(Trans)) were calculated using the maximum-slope and a delay-corrected modified Patlak approach and were correlated to MVD and LVD. The relationship between CT perfusion and the prognostic markers pT stage, Fuhrman grade, and tumor necrosis was evaluated.

RESULTS

Histopathology revealed varying high MVD but low or absent intratumoral LVD. The BF and BV of RCC, both including and excluding necrotic regions, showed significant correlations with MVD (r = 0.600-0.829, P < 0.05 each). Significant correlations between MVD and K(Trans) were found only in small tumor areas exhibiting no necrosis (r = 0.550, P < 0.05). No significant correlation was found between BF, BV, and K(Trans) with intratumoral LVD (P = 0.35-0.82). With higher pT stage and Fuhrman grade, BF, BV, and K(Trans) were lower, similar to the MVD, but without reaching statistical significance. Blood flow, BV, and K(Trans) were significantly higher in RCCs with less than 50% necrosis than in those with 50% or grater necrosis (P < 0.05 each).

CONCLUSION

Our study indicates that BF and BV from CT perfusion reflect blood vessels of RCC. Computed tompgraphic perfusion parameters differ significantly depending upon the degree of tumor necrosis.

摘要

目的

本研究旨在系统分析肾癌（RCC）患者 CT 灌注与组织病理学血管生成和预后标志物之间的相关性。

材料与方法

15 名 RCC 患者（12 名男性；平均年龄 64.5±9.4 岁）于术前 1 天接受了对比增强 CT 灌注成像（扫描范围 10cm；扫描时间 40 秒；双源 128 层 CT）。对手术标本处理的程序进行了修改，以便与 CT 图像完全匹配。采用 CD34 染色对微血管密度（MVD）进行量化，并用 D2-40 抗体对淋巴管密度（LVD）进行染色。采用最大斜率和延迟校正改良 Patlak 法计算 CT 灌注值血流量（BF）、血容量（BV）和血流提取产物（K（Trans）），并将其与 MVD 和 LVD 相关联。评估 CT 灌注与预后标志物 pT 分期、Fuhrman 分级和肿瘤坏死之间的关系。

结果

组织病理学显示不同程度的高 MVD 但低或无肿瘤内 LVD。RCC 的 BF 和 BV（包括和不包括坏死区域）均与 MVD 呈显著相关性（r=0.600-0.829，P<0.05）。仅在无坏死的小肿瘤区域发现 MVD 与 K（Trans）之间存在显著相关性（r=0.550，P<0.05）。BF、BV 和 K（Trans）与肿瘤内 LVD 之间无显著相关性（P=0.35-0.82）。随着 pT 分期和 Fuhrman 分级的升高，BF、BV 和 K（Trans）降低，与 MVD 相似，但无统计学意义。肿瘤坏死小于 50%的 RCC 中 BF、BV 和 K（Trans）明显高于肿瘤坏死大于或等于 50%的 RCC（P<0.05）。