Hawighorst H, Knapstein P G, Weikel W, Knopp M V, Zuna I, Knof A, Brix G, Schaeffer U, Wilkens C, Schoenberg S O, Essig M, Vaupel P, van Kaick G
Department of Radiological Diagnostics, German Cancer Research Center, Heidelberg.
Cancer Res. 1997 Nov 1;57(21):4777-86.
Dynamic studies of Gd-based contrast agents in magnetic resonance imaging (MRI) are increasingly being used for tumor characterization as well as therapy response monitoring. Because detailed knowledge regarding the pathophysiological properties, which in turn are responsible for differences in contrast enhancement, remains fairly undetermined, it was the aim of this project to: (a) examine the relationship between contrast-enhanced dynamic MRI-derived characteristics and histological microvessel density counts, a recognized surrogate of tumor angiogenesis, from primary or recurrent cancers of the uterine cervix; and (b) correlate these parameters with lymphatic involvement to characterize tumor aggressiveness in terms of lymphatic spread. Pharmacokinetic parameters (amplitude, A; exchange rate constant, k21) were calculated from a contrast-enhanced dynamic MRI series in 55 patients (ages 25-72 years; mean, 50 years) with biopsy-proven primary (n = 42) or recurrent (n = 13) uterine cervical cancer. Both pharmacokinetic parameters were correlated to histologically determined microvessel density counts (factor VIII-related antigen) and other pathological tumor characteristics obtained from the operative specimens after radical surgery. In addition, the magnetic resonance and histological data were correlated to the presence or absence of lymphatic system involvement. Pharmacokinetic MRI-derived parameters (A and k21) increased with increasing histological microvessel density counts with r = 0.41 and 0.50, respectively. Lymphatic involvement was more comprehensibly assessed by the pharmacokinetic parameter k21 compared with histological microvessel density, resulting in a higher sensitivity, overall accuracy, and comparable specificity. Contrast-enhanced MRI parameters might prove to be applicable for estimation of tumor angiogenesis in uterine cervical cancer; thus, MRI may become an additional tool to characterize malignant progression in terms of lymphatic involvement in uterine cervical cancer.
基于钆的造影剂在磁共振成像（MRI）中的动态研究越来越多地用于肿瘤特征描述以及治疗反应监测。由于关于病理生理特性的详细知识（这些特性反过来又导致对比增强的差异）仍然相当不确定，因此本项目的目的是：（a）研究对比增强动态MRI衍生特征与组织学微血管密度计数（一种公认的肿瘤血管生成替代指标）之间的关系，这些数据来自子宫颈原发性或复发性癌症；（b）将这些参数与淋巴受累情况相关联，以根据淋巴扩散来表征肿瘤侵袭性。从55例活检证实为原发性（n = 42）或复发性（n = 13）子宫颈癌患者（年龄25 - 72岁；平均50岁）的对比增强动态MRI系列中计算药代动力学参数（幅度，A；交换率常数，k21）。这两个药代动力学参数均与组织学确定的微血管密度计数（因子VIII相关抗原）以及根治性手术后从手术标本中获得的其他病理肿瘤特征相关。此外，磁共振和组织学数据与淋巴系统受累的有无相关。药代动力学MRI衍生参数（A和k21）随着组织学微血管密度计数的增加而增加，r分别为0.41和0.50。与组织学微血管密度相比，药代动力学参数k21能更全面地评估淋巴受累情况，具有更高的敏感性、总体准确性和相当的特异性。对比增强MRI参数可能适用于评估子宫颈癌中的肿瘤血管生成；因此，MRI可能成为根据子宫颈癌淋巴受累情况来表征恶性进展的另一种工具。
