【作者】 张勇；

【导师】 陈方满；

【作者基本信息】 皖南医学院 ， 影像医学与核医学， 2016， 硕士

【摘要】 目的:探讨胃癌的影像学表现与MVD、VEGF表达的相关性关系,并以此通过影像学表现来判断胃癌的恶性程度和预后评估。方法:收集弋矶山医院2014年09月到2015年12月期间收住入院经影像学诊断、病理结果确诊的50例胃癌病人,全部患者术前予以X线钡剂造影、腹部螺旋CT扫描检查,术后所得肿瘤组织经免疫组织化学染色,对结果进行对照分析。结果:(1)X线钡剂造影检查胃癌50例:发生部位分别为贲门-胃底区19例、胃体部6例、胃窦-幽门部19例、全胃6例。进展期胃癌分为蕈伞型14例,溃疡型7例,浸润溃疡型10例,浸润型5例。(2)多排螺旋CT检查对胃癌的T、N、M分期结果与病理结果符合率分别为60.0%、90.0%和100%;TNM分期完全一致的符合率为54%。CT表现为胃壁增厚36例,肿块形成28例,有淋巴结转移36例,胃腔狭窄者15例,突破、侵犯浆膜者30例;CT 强化幅度范围为 46.5-100.2HU,平均 72.54±12.39HU。(3)50例胃癌病例MVD计量数值为12-39条/高倍镜视野,平均29.08±7.162条/高倍镜视野。淋巴结转移阳性组的MVD值高于淋巴结转移阴性组的MVD值,两组比较差异具有统计学意义;突破、侵犯浆膜组及无浆膜侵犯、破坏组的MVD计量数值两组比较差异具有统计学意义。(4)50例胃癌病例中VEGF高表达为34例,为68.0%(32/50),低表达16例,为32.0%(16/50);CT检查结果:在淋巴结转移阳性组及阴性组,VEGF的高表达率分别为86.1%(31/36)和21.4%(3/14),两组比较差异有统计学意义;侵犯、破坏浆膜组及无浆膜侵犯、破坏组的高表达率分别为76.7%(23/30)和55.5%(11/20),两组比较差异无统计学意义。VEGF高表达率与胃癌部位、类型无相关性。(5)胃癌的强化峰值(PA)与MVD计算数值之间存在显著的直线正相关关系。Pearson相关系数为(r= 0.76,t=6.910,P<0.001),通过线性回顾分析得出(F=47.747,P<0.01),两者具有直线回归关系;VEGF高表达组的强化峰值(PA)和MVD计算数值显著高于VEGF低表达组(t=-3.941,P<0.001)。结论:1、数字胃肠造影检查可以作为可靠的胃癌诊断手段,CT检查对胃癌的TNM分期准确性与病理检查结果相当,两者联合应用可提高对胃癌的诊断、分期、预后评估有一定价值。2、胃癌发生部位、类型与胃癌的MVD表达无统计学相关性。胃癌发生部位与胃癌的VEGF高表达率无统计学相关性;胃癌的发生类型与胃癌的VEGF高表达率有统计学相关性。3、胃癌淋巴结转移、浆膜侵犯征象可以反映胃癌的MVD、VEGF表达情况,淋巴结转移、浆膜侵犯与胃癌的MVD及VEGF表达呈正相关。4、胃癌组织的CT强化峰值(PA)与胃癌组织微血管密度、VEGF的表达呈正相关,可作为判断肿瘤恶性程度和预后评估的一项指标。更多还原

【Abstract】 Objective:Study on the relationship between the imaging manifestations and MVD-and-VEGF expressing of gastric carcinomaMethods:select 50 cases of patients from Yijishan hospiotal who were diagnosed as gastric carcinoma by the imaging examination and pathological examination from 2014 September to 2015 December,all the 50 patients should take X-ray barium meal examinations and abdominal spiral scanning before surgery,and the tumor tissues take immunohistochemical staining after surgery,and the results were compared to study.Results:(1)50 cases of gastric cancer were detected by X-ray barium examination:According to the site,19cases of gastric fundus and cardiac region,6 cases of gastric body,19 cases of gastric antrum and pylorus,and 6 cases of diffuse type;according to general types the advanced gastric cancers were divided into 14 cases of mushroom type,limited ulcer type 7 cases,infiltrative ulcer in 10 cases,and 5 cases were diffuse type.(2)The accuracy of MSCT in determining T、N and M staging of GC was 86.0%,74.1%and 100%respectively,and the accuracy of the total TNM staging was 82.0%.The CT manifestation included thickening of gastric wall(36 cases)、mass formation(28 cases)、regional lymphnode metastasis(36 cases)、stenosis(5 cases)、breakthrough and invade serosa(23 cases);The enhanced sizes on CT were from 46.5-100.2HU,the average 72.54HU.(3)The measured numerical values of MVD are12-39 MVD per high magnificationof all the 50 patients,average 29.08 per high magnification.MVD of Lymph node metastasis positive group is higher than in lymph node negative group,The breakthrough,serosa invasion group and MVD without serosal invasion and destruction of measurement value difference between groups of two groups were not statistically significant;(4)The high expression of VEGF is 34 cases of all the 50 patients,68.0%(34/50);The low expression of VEGF is 16 cases,32.0%(16/50).In the lymph node positive group and negative group,the high expression rate of VEGF was 86.1%(31/36)and 21.4%(3/14).There was significant difference between two groups(P<0.05).Invasion,breakthrough serosa group and non high expression of serosa invasion,destruction group rates were 76.7%(23/30)and 55.5%(11/27),There was significant difference between two groups(P<0.05).Location,rate of gastric cancer and high expression of VEGF had no correlation with general type.(5)There is a significant correlation Peak enhancement of gastric cancer(PA)between the numerical calculation and MVD(r= 0.708,t= 5.015,P<0.001);The high expression of VEGF enhanced peak group(PA)and MVD numerical calculation was significantly higher than that of VEGF low expression group(rank sum test,0.025<P<0.05)Conclusion:(1)Digital gastrointestinal examination can be used as a reliable means of diagnosis of gastric cancer,CT scan of gastric cancer TNM staging and pathological examination results,the combination of the two methods can improve diagnosis,staging and prognosis of gastric cancer ability.(2)The location and of gastric cancer have no correlation with MVD expression of gastric cancer.The location of gastric cancer have no correlation with high expression rate of VEGF;the type of gastric cancer have correlation with high expression rate of VEGF.(3)The signs of Lymph node metastasis and serosal invasion of gastric can reflect the expression of VEGF,lymph node metastasis and serosal invasion of gastric cancer have positive correlation with the MVD and VEGF expression of gastric cancer.(4)The CT peak enhancement(PA)expression in gastric cancer have positive correlation with the exprssion of microvessel density and VEGF of gastric cancer,and could be used as a index to judge the malignant degree and prognosis.更多还原