【摘要】 目的研究鼻咽癌 CT 灌注值与肿瘤微血管密度（MVD）、肿瘤分期的关系,探讨多层螺旋 CT 灌注成像对鼻咽癌的临床应用价值。方法 49例鼻咽部 CT 灌注检查中,鼻咽癌组30例,鼻咽癌放疗后组14例,正常鼻咽部5例,测量鼻咽癌和鼻咽黏膜位置的血流量（BF）、最大强化指数（PEI）、峰值到达时间（TTP）及血容量（BV）作为灌注指标,其中16例鼻咽癌活检组织行免疫组织化学 CD34单抗染色后,Weidner 方法计数 MVD。各组灌注值比较行方差分析,CT 灌注值、肿瘤分期与MVD 之间行 Spearman 等级相关分析。结果 49例中1例鼻咽癌灌注检查失败。鼻咽癌组（29例）肿瘤 CT 灌注值 BF 为（48.6±16.9）ml·100 g^-1·min^-1,PEI 为（32.3±7.9）HU,TTP 为（17.5±4.9）s,BV 为（12.8±4.4）ml·100 g^-1;正常对照组（5例）BF、PEI、TTP、BV 值分别为（15.9±5.9）ml·100 g^-1·min^-1、（12.6±1.3）HU、（22.6±6.9）s、（3.5±0.5）ml·100 g^-1;鼻咽癌放疗后组（14例）BF、PEI、TTP、BV 值分别为（25.2±7.0）ml·100 g^-1·min^-1、（19.8±5.9）HU、（22.6±4.3）s、（6.1±2.4）ml·100 g^-1,三组各灌注值差异有统计学意义（P 值均<0.01）;相关分析显示,鼻咽癌组（29例）中 TNM 分期（其中Ⅰ期3例,Ⅱ期9例,Ⅲ期10例,Ⅳ期7例）与 PEI 和 BV 存在相关性（r 值分别为0.48和0.50）,与 BF 和 TTP 无明显相关性（r 值分别为0.23和0.22）;16例鼻咽癌MVD 为（30.8±12.6）个/高倍镜视野,与其 BF（51.4±17.0）ml·100 g^-1·min^-1、PEI（33.2±9.6）HU 和 TTP（16.3±4.1）s 存在相关性（r 值分别为0.85、0.60和0.78）,与 BV（13.2±5.6）ml·100 g^-1弱相关（r=0.48）。结论鼻咽癌有着特征的 CT 灌注表现,多层螺旋 CT 灌注成像的灌注值可以反映鼻咽癌微血管密度特征,PEI 和 BV 值与鼻咽癌的 TNM 分期存在一定的相关性。更多还原

【Abstract】 Objective To explore the correlation between MSCT perfusion parameters and biologic characters in nasopharyngeal carcinoma（NPC）,and to investigate the clinical utility of MSCT perfusion for NPC.Methods Nasopharynx in 49 cases was studied using MSCT perfusion imaging,including 30 NPC cases before radiotherapy,14 post-radiotherapy NPC cases,and 5 cases of normal nasopharynx as controls. The perfusion data of tumors and nasopharyngeal wall such as blood flow（BF）,peak enhancement index （PEI）,time to peak （TTP）,and blood volume （BV）were calculated.MVD defined by CD34 stain was counted in 16 cases of NPC.The correlation of MSCT perfusion parameters,MVD,and clinical stage was analyzed.Results 1 case of NPC failed in CT perfusion exam.In NPC group （n=29）,BF,PEI,TTP, and BV were （48.6±16.9）ml·100 g^-1·min^-1,（32.3±7.9）HU,（17.5±4.9）s,and （12.8± 4.4）ml·100 g^-1,respectively.BF,PEI,TTP,and BV in control group （5 cases）were （15.9± 5.9）ml·100g^-1·min^-1,（12.6±1.3）HU,（22.6±6.9）s,and （3.5±0.5）ml·100 g^-1, respectively,and those in post-radiotherapy group （14 cases）were （25.2±7.0）ml·100 g^-1·min^-1, （19.8 ±5.9）HU,（22.6±4.3 ）s,and （6.1±2.4）ml·100 g^-1,respectively.The perfusion values in NPC group had significant difference compared with those in the other two groups （P<0.01 ）.In NPC group （29 eases,including stage Ⅰin 3 cases,stage Ⅱin 9 eases,stageⅢin 10 cases,and stageⅣin 7 cases）,PEI and BV were correlated with clinical TNM stage（r = 0.48,r = 0.50）,BF and TIP had no correlation with clinical stage（r = 0.23,r = 0.22）.The value of MVD in NPC group（16 cases）was （30.78±12.6）/HP,which was eorrelated with BF （51.4±17.0）ml·100 g^-1min^-1, PEI （33.2± 9.6）HU,and TTP（16.3 ±4.1）s （r =0.85,r =0.60,and r =0.78）,and was slightly correlated with BV（13.2±5.6）ml·100g-1 （r = 0.48）.Conclusion MSCT peffusion can be utilized in nasopharyngeal carcinoma as a quantitative functional imaging technique.MSCT perfusion data can reflect the characters of micro-vessel of NPC and clinical stage.更多还原