【摘要】 目的:运用多层螺旋CT(MSCT)获取肾癌和肾盂癌的灌注图像,并与其分子病理学特征相对照,探讨MSCT灌注成像在肾癌和肾盂癌诊断和鉴别诊断中的临床应用价值。方法:对53例疑有肾肿瘤的患者行MSCT灌注扫描,获得伪彩色的血流灌注参数图,包括血流量(BF)、血容量(BV)、表面通透性(PS)及平均通过时间(MTT)图。在瘤体及瘤旁正常肾皮质选取感兴趣区并记录相应的各项参数值。所有患者均经手术病理证实。53例中肾癌47例,肾盂癌6例。采用免疫组化方法(SP法)检测肾肿瘤中血管内皮生长因子(VEGF)的表达及微血管密度(MVD)。结果:肾细胞癌的BF、BV和PS值均明显低于正常肾皮质,且Ⅲ级肾癌与Ⅰ、Ⅱ级相比,其BF、BV和PS值明显增高。肾盂癌的各项灌注参数值明显低于肾癌。肾癌的BF、BV、PS值与其VEGF平均光密度值呈正相关(P<0.05),MTT值与VEGF平均光密度值呈负相关(P<0.05)。肾癌的MVD值与VEGF值呈正相关(P<0.05)。结论:MSCT灌注成像能定量评价肿瘤血管生成、血流灌注及血管通透性改变,有助于肾细胞癌的术前分级,并在肾癌和肾盂癌的定性诊断和鉴别诊断方面有一定临床应用价值。更多还原

【Abstract】 Objective:To study the correlation of the perfusion CT parameters and the molecular pathology characte- ristics of the renal cell carcinoma (RCC) and renal pelvic carcinoma (RPC),and to discuss the value of multi-slice CT (MSCT) perfusion imaging in the diagnosis and differential diagnosis of RCC and RPC.Methods:53 patients with clinically suspected renal tumors underwent MSCT perfusion imaging.The maps of renal blood volume (BV),blood flow (BF),permeability surface (PS) and mean transit time (MTT) were obtained.Regions of interest (ROI) were drawn within the tumor and the region of normal area adjacent to the tumor.All of the tumors were proved by surgery and pathology with RCC (n= 47) and RPC (n=6).Vascular endothelial growth factor (VEGF) expression and micro-vascular density (MVD) were measured with immuno-histology chemistry technique (SP technique).Results:Of the 47 RCC,the mean BF,BV and PS value were obviously lower than that of normal renal cortex;moreover,the above-mentioned parameters in grade Ⅲ were significantly higher than that of grade Ⅰ and Ⅱ RCC.The perfusion parameters of RCC were much higher than that of RPC.A significant inverse correlation (r=0.673,P<0.01) was observed between the mean MTT value and the VEGF expression.The mean BF,BV and PS of RCC had a significant positive correlation with VEGF expression (P<0.05).Conclusion:Tumor angiogenesis,blood flow perfusion and permeability surface could be quantitatively evaluated by MSCT perfusion imaging.It provides useful information for pre-surgical staging of RCC and benefits the clinical diagnosis and differen- tial diagnosis of RCC and RPC.更多还原