【摘要】 目的探讨256层螺旋CT结直肠癌全肿瘤灌注成像与肿瘤分期及肿瘤内血管生成相关性。方法对2010年7月至2012年11月在本院普外科术前经纤维结肠镜检查并由术后病理证实的结直肠腺癌患者37例[男23例,女14例,年龄(64.54±11.66)岁]进行256层螺旋CT全肿瘤灌注分析,并对术后标本多层面取材,采用鼠抗人单克隆抗体CD105(Anti-CD105/Endoglin)进行免疫组织化学染色,以患者为单位测定肿瘤组织内血管生成情况。将全肿瘤灌注参数与临床病理参数(TNM分期、淋巴结及远处转移)、肿瘤内血管生成情况进行分析比较。分别运用Spearman相关性检验、Pearson相关性检验分析全肿瘤灌注参数与肿瘤TNM分期、肿瘤内血管生成情况相关性。运用独立样本t检验分析淋巴结及远处转移阳性组与阴性组灌注参数之间差异。P<0.05表明差异具有统计学意义。结果肿瘤平均长度(5.93±2.35)cm。37例标本共取材97处(平均每例2.6处),以患者为单位计算肿瘤内微血管密度(MVD)平均值。37例患者Ⅰ期3例,Ⅱ期15例,Ⅲ期11例,Ⅳ期8例。全肿瘤灌注参数血流量(BF)、TTP与肿瘤TNM分期存在相关性(r=-0.673,P<0.001;r=0.644,P<0.001)。全肿瘤灌注参数血流量(BF)、血容量(BV)、达峰时间(TTP)与肿瘤内MVD均无明显相关性(r=0.201,P=0.233;r=0.295,P=0.076;r=-0.178,P=0.292)。淋巴结及远处转移阳性组与阴性组灌注参数比较,BF、TTP存在明显统计学差异(P=0.045;P=0.002),BV不存在统计学差异(P=0.134)。结论 256层CT结直肠癌全肿瘤灌注与肿瘤TNM分期具有良好相关性,在一定程度上可以反映肿瘤临床病理学特征;但结直肠癌全肿瘤灌注参数与MVD值不具有明显相关性。更多还原

【Abstract】 Objective To discuss the clinical application of whole tumor perfusion scanning of colorectal cancer with 256-slice spiral CT scanner in evaluating tumor stage,and to investigate the correlation of tumor TNM stage with angiogenesis. Methods Thirty-seven patients with pathologically-proved colorectal cancer,who were encountered at authors’ hospital during the period from July 2010 to November 2012,were enrolled in this study. The patients consisted of 23 males and 14 females with a mean age of( 64. 54 ± 11. 66) years. Whole volume perfusion CT scanning by using a 256-slices CT scanner was performed in all 37 patients. Multiple pathologic slices were selected with an interval of 1- 2 cm. Immunohistochemical staining( Envision method) of the tumor specimens was performed by using mouse anti-human monoclonal antibody( Anti-CD105 / Endoglin),and the tumor angiogenesis was determined. The results were analyzed with SPSS 17. 0 commercial software. Tumor perfusion parameters,clinico-pathological parameters and microvessel density were compared by using Spearman correlation analysis method and Pearson correlation analysis method. By using independent samples t test,the tumor perfusion parameters of lymph nodes metastasis positive group were compared with those of lymph nodes metastasis negative group. The difference was considered to be statistically significant when P < 0. 05. Results The average tumor length was( 5. 93 ± 2. 35) cm. A total of 37 specimens were collected and were divided into 97 paraffin blocks( av-erage 2. 6 /per specimen). Mean micro-vessel density( MVD) count was calculated by a single individual patient as a sample. Of the 37 patients,stage Ⅰ was pathologically confirmed in 3,stage Ⅱ in 15,stage Ⅲ in 11 and stage Ⅳ in 8 according to AJCC cancer staging standard. A significant correlation existed between TNM stage and the blood flow( BF)( r=- 0. 673,P < 0. 001) as well as the time to peak( TTP)( r = 0. 644,P < 0. 001). No close correlation existed between MVD and BF( r = 0. 201,P = 0. 233),blood volume( BV)( r = 0. 295,P = 0. 076) as well as TTP( r =- 0. 178,P =0. 292). The differences in BF and TTP between positive metastasis group and negative metastasis group were statistically significant( P = 0. 045; P = 0. 002),while the difference in BV was not significant( P = 0. 134). Conclusion Whole tumor perfusion scanning of colorectal cancer with 256-slice spiral CT scanner indicates that the perfusion parameters are well correlated with tumor TNM stage,which can reflect the clinico-pathological features of colorectal cancer to a certain degree,although no definite correlation exists between MVD and the whole tumor perfusion parameter.更多还原