Fu Liang, Pan Xiaoyu, Ding Haiming, Qin Ying, Huang Wanyun, Lu Shunzu, Li Kai, Long Liling
Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor of Guangxi Medical University, Ministry of Education, Nanning, China.
J Thorac Dis. 2025 Jan 24;17(1):19-30. doi: 10.21037/jtd-24-1467. Epub 2025 Jan 22.
Alterations in the vascular microenvironment of cancer have gradually gained widespread attention in oncology research, and early qualitative diagnosis using noninvasive examination techniques is crucial in clinical practice. This study aimed to explore the value of quantitative parameters of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in the assessment of vascular architecture of solid solitary pulmonary nodules (SSPNs).
DCE-MRI scan images of a total of 79 patients with SSPNs from November 2021 to December 2023 were prospectively analyzed. Quantitative permeability parameters K, K, and V values of the lesions were measured, labeled immunohistochemically with CD31 microvessel density (CD31-MVD), smooth muscle actin microvessel density (SMA-MVD), and vascular endothelial growth factor (VEGF), and quantitative values of vascular architectural parameters were obtained using the image analysis software Image-J. The diagnostic efficacy of quantitative permeability parameters for the diagnosis of malignant SSPNs was analyzed by receiver operating characteristic (ROC) curves using surgical pathology findings as the gold standard for the diagnosis of malignant SSPNs. Spearman's correlation analysis was used to evaluate the relationship between quantitative permeability parameters and vascular construct parameters.
The study included 51 female patients (64.6%) with a mean age of 50.5±11.5 years. Only 21 patients (26.6%) had a smoking history, and 30 patients (38.0%) had a normal weight. Statistically significant differences were found between benign and malignant SSPNs subgroups in K and V values in quantitative permeability parameters, and in SMA-MVD and microvascular perfusion index (MPI) in vascular conformation parameters (P<0.05). K and V values showed high diagnostic value for malignant SSPNs [area under the curve (AUC), 0.813 and 0.759]. K, K, and V were significantly positively correlated with CD31-MVD, with r-values of 0.857, 0.830, and 0.798 (P<0.05); they were also significantly positively correlated with VEGF, with r-values of 0.851, 0.859, and 0.764 (P<0.05); and K and K were significantly negatively correlated with MPI, with r-values were -0.779 and -0.864 (P<0.05).
The quantitative permeability parameters of DCE-MRI correlate with some of the vascular architectural parameters, and magnetic resonance image-based quantification of pulmonary nodal vascular architecture provides a noninvasive method for the differential diagnosis of SSPNs.
癌症血管微环境的改变在肿瘤学研究中逐渐受到广泛关注，在临床实践中使用非侵入性检查技术进行早期定性诊断至关重要。本研究旨在探讨动态对比增强磁共振成像（DCE-MRI）定量参数在评估实性孤立性肺结节（SSPNs）血管结构中的价值。
前瞻性分析了2021年11月至2023年12月期间共79例SSPNs患者的DCE-MRI扫描图像。测量病变的定量通透性参数K、K和V值，用CD31微血管密度（CD31-MVD）、平滑肌肌动蛋白微血管密度（SMA-MVD）和血管内皮生长因子（VEGF）进行免疫组织化学标记，使用图像分析软件Image-J获得血管结构参数的定量值。以手术病理结果作为恶性SSPNs诊断的金标准，通过受试者操作特征（ROC）曲线分析定量通透性参数对恶性SSPNs诊断的效能。采用Spearman相关性分析评估定量通透性参数与血管构建参数之间的关系。
该研究纳入51例女性患者（64.6%），平均年龄50.5±11.5岁。仅21例患者（26.6%）有吸烟史，30例患者（38.0%）体重正常。在定量通透性参数的K和V值以及血管构象参数的SMA-MVD和微血管灌注指数（MPI）方面，良性和恶性SSPNs亚组之间存在统计学显著差异（P<0.05）。K和V值对恶性SSPNs显示出较高的诊断价值[曲线下面积（AUC）分别为0.813和0.759]。K、K和V与CD31-MVD显著正相关，r值分别为0.857、0.830和0.798（P<0.05）；它们也与VEGF显著正相关，r值分别为0.851、0.859和0.764（P<0.05）；K和K与MPI显著负相关，r值分别为-0.779和-0.864（P<0.05）。
DCE-MRI的定量通透性参数与一些血管结构参数相关，基于磁共振图像对肺结节血管结构进行量化为SSPNs的鉴别诊断提供了一种非侵入性方法。
