胰腺癌CT灌注成像表现及其生物学相关性研究  

Biological Relativity of Imaging of CT Perfusion for Pancreases to Pancreatic Cancer

作　　者：程祝忠[1] 许国辉[1] 黄娟[2] 阳宁静[2] 杨宇洁[1] 曹英[1] 何韧[1] 席晓秋[1] 

机构地区：[1]四川省肿瘤医院影像科,成都610041 [2]四川大学华西医院放射科

出　　处：《四川大学学报（医学版）》2009年第3期521-524,共4页Journal of Sichuan University(Medical Sciences)

摘　　要：目的探讨多层螺旋CT灌注成像对胰腺癌的临床应用价值,以及胰腺癌CT灌注值与肿瘤微血管密度(MVD)、血管内皮生长因子(VEGF)的关系。方法正常胰腺42例,胰腺癌患者18例,行多层螺旋胰腺CT灌注检查,采用螺旋CT自带软件绘制感兴趣区(ROI)的时间-密度曲线(TDC),并计算ROI强化峰值CT灌注参数:血流量(BF)、血流容积(BV)、灌注起始时间(TTS)、达峰时间(TTP)、渗透性、patlak血流容积(pBV)的平均值。选择20例(胰腺癌组11例,慢性胰腺炎9例)切取与CT灌注靶层面相同的组织层面切片,行CD34、VGEF抗体免疫组织化学染色,分析肿瘤CT灌注成像表现与MVD、VEGF表达的相关性。结果胰腺癌组的BF、BV、pBV明显低于正常组(P均<0.01),胰腺癌组的渗透性高于正常胰腺组(P<0.01);两组间的灌注起始时间和达峰时间比较差异无统计学意义。9例慢性胰腺炎的MVD为(13.8±9.6),11例胰腺癌的MVD为(30.5±14.8),两者差异有统计学意义(P=0.01)。VEGF在胰腺癌呈强阳性表达者8例,弱阳性表达者3例,在慢性胰腺炎中呈强阳性表达者1例,弱阳性表达者8例,VEGF的表达阳性率在慢性胰腺炎、胰腺癌差异有统计学意义(P<0.01)。胰腺癌患者MVD(中位数40.2)与BF(中位数26.9)、TTS(中位数14.8)和TTP(中位数145.3)呈正相关(r值分别为0.42、0.63和0.45,P均<0.05),VGEF(中位数为4.3)表达与BV(中位数18.2)呈负相关(r=-0.39,P<0.05)。结论CT灌注成像对胰腺癌的诊断有一定的临床价值。MVD、VEGF与CT灌注值相关,CT灌注成像可以反映肿瘤微循环情况。Objective To explore the relationships between perfusion values of pancreatic cancers and the microvessel density of tumors （MVD） and vessel endothelial growth factor （VEGF）, and the clinical value of multiple-slice spiral CT perfusion imaging in diagnosing pancreatic cancers. Methods Forty-two people with normal pancreas and eighteen patients with pancreatic cancers underwent multiple-slice spiral CT perfusion examinations. The time-density curve （TDC） of the region of interest （ROI） was drawn with the software equipped in the spiral CT. The CT perfusion parameters of the ROI peak reinforcement values were calculated, including blood flow （BF0, blood volume （BV）, time to start （TTS）, time to peak （TTP）, permeability, and mean of the patlak blood volume （pBV）. Twenty patients （11 with pancreatic cancers and 9 with chronic pancreatitis） were chosen for CD34 and VGEF antibody immunohistochemistry staining on the same layers of pancreatic tissues as the CT perfusion targeted. The associations between the imaging of CT perfusion and MVD and VFGF were examined. Results The patients with pancreatic cancers had lower BF, VB, and pBV, and higher permeability than the normal controls （P 〈0.01）. No differences appeared between the two groups in time to start and time to peak （P〈0.05）. The difference in average MVD of the 9 patients with chronic pancreatitis （13. 8±9. 6）, and the 11 patients with pancreatic cancers （30.5± 14.8） was statistically significant. Eight patients with pancreatic cancers showed strong positive VEGF and three showed weak positive VEGF. Only one patient with chronic pancreatitis showed strong positive VEGF while eight showed weak positive VEGF. The difference in positive rate of VEGF between the two groups of patients was statistically significant （P〈0.01）. The MVD in patients with pancreatic cancers （median 40.2） was correlated with BF （median 26.9）, TTS （median 14.8）, and TTP （median 145.3） （r=0.42, 0.63, and 0.45,

关 键 词：体层摄影术 X线计算机 灌注 胰腺肿瘤 病理学 

分 类 号：R735.9[医药卫生—肿瘤]