【摘要】 目的　探讨乳腺良恶性病变动态增强MRI表现特征与微血管密度 (MVD)和血管内皮生长因子 (VEGF)表达水平之间的相关性。方法　以 3 8例行动态增强MR乳腺检查并经病理及组织切片免疫组织化学 (简称免疫组化 )染色证实的患者为研究对象。动态增强MRI评价病变指标包括 :早期增强率、强化峰值和时间 信号强度曲线。病理组织切片经Ⅷ因子相关抗原和VEGF免疫组化染色 ,测定病变组织MVD和VEGF表达水平 ,并进一步分析动态增强MRI上述表现特征、MVD和VEGF之间的相互关系。结果　 3 8例中 ,恶性病变 2 1例 ,良性病变 17例。恶性病变MVD和VEGF表达水平高于良性病变 ,差异具有非常显著意义 (P <0 0 1) ,且VEGF表达水平与MVD呈正相关性 (P <0 0 1)。在 3 8例乳腺良恶性病变中 ,早期增强率 >60 %和曲线类型为Ⅱ、Ⅲ型的乳腺病变的MVD和VEGF表达水平明显高于早期增强率 <60 %和曲线类型为Ⅰ型的乳腺病变 ,除时间 信号强度曲线类型分布与VEGF表达水平之间差异无显著意义外 (P >0 0 5 ) ,其余差异均具有非常显著意义 (P <0 0 1)。乳腺良恶性病变强化峰值之间差异无显著意义 (P >0 0 5 )。分析微血管分布显示恶性病变外周与中央区MVD的比值 (1 2 7)高于良性病变外周与中央区MVD的比值 (1 12 ) ,且恶性病变边缘区MVD高?更多还原

【Abstract】 Objective To determine whether dynamic contrast enhanced MRI features of early-phase enhancement rate, enhancement amplitude, and signal intensity (SI) time course are associated with the microvessel density (MVD) and vascular endothelial growth factor (VEGF) expression of malignant and benign breast lesions. Methods Thirty-eight patients with histopathologically verified breast lesions underwent dynamic contrast enhanced MRI. SI changes during dynamic scanning were assessed quantitatively. Early-phase enhancement rate and enhancement amplitude were calculated. Time-SI curves of the lesions were obtained and classified according to their shapes as type Ⅰ (which was steady enhancement to the end of the dynamic data acquisition at 7.5 min), type Ⅱ (plateau of SI after avid initial contrast enhancement), or type Ⅲ (washout of SI after avid initial contrast enhancement). The mean MVD and VEGF expression of the lesions were measured with immuno-histochemical staining method in all the histologic specimens by pathologists without the knowledge of the results of the MR examination. The relationships among dynamic contrast enhanced MRI features, MVD, and VEGF expression of benign and malignant breast lesions were analyzed. Results Histology revealed 21 malignancies and 17 benign lesions. The mean MVD and VEGF expression for 21 malignant lesions were statistically higher than the mean MVD and VEGF expression for 17 benign lesions. High VEGF expression of benign and malignant breast lesions showed an association with increased MVD. Among all 38 lesions, greater (>60%) MR early-phase enhancement rate and time-SI curve type Ⅱ and Ⅲ showed an association with increased MVD and higher VEGF expression level. All the differences mentioned above showed statistical significance except that the difference between VEGF expression and the distribution of curve types had no statistical significance. No significant relationships were observed between the mean of enhancement amplitude and MVD or VEGF expression. Regarding the distribution of MVD, the study showed that the greater MVD was most frequently observed at the marginal region of breast cancer, although the distribution of MVD was heterogeneous in each lesion. Conclusion MVD and VEGF affect the contrast medium enhancement of breast lesions. The early-phase enhancement rate and time-SI curve types of benign and malignant breast lesions are closely related to MVD and VEGF. As a noninvasive method, contrast enhanced MRI has a potential role in estimating the degree of angiogenesis of breast neoplasm.更多还原