摘要
目的探讨进展期胃癌术前CT增强表现与肿瘤血管生成的相关性,评价螺旋CT增强扫描对胃癌术前分期的诊断价值。方法对经手术或活检证实的胃癌21例,术前行水充盈螺旋CT低张平扫及三期增强扫描,并测定肿瘤区域的CT值。胃癌标本组织切片经CG34抗原单克隆抗体和抗血管内皮生长因子(VEGF)多克隆抗体二种试剂分别做免疫组织化学染色,测定肿瘤的微血管密度(MVD)和VEGF阳性表达率。将CT形态表现、强化程度及特征与组织学结果进行比较。结果螺旋CT术前对胃癌TNM分期符合率为80.5%。癌灶CT最大强化增加值为36～80HU,平均60.16HU;肿瘤MVD平均13.15条/高倍镜视野。肿瘤实质的最大CT强化值与MVD之间存在显著的相关性(P<0.001);VEGF阳性组的MVD和强化峰值(PA)显著高于VEGF阴性组(P<0.05)和VEGF弱阳性组(P<0.05);胃癌的分化程度与VEGF表达成正相关。结论进展期胃癌的CT强化特点能够总体上反映癌组织的血管生成情况,可作为与VEGF有关的肿瘤血管生成的一项指标,对评估胃癌的手术方案及临床治疗有较大的价值。
Objective To investigate the relationship between CT enhancement and tumor angiogenesis in gastric carcinoma （GC） and evaluate the diagnostic value of contrast- enhanced helical hydro- CT（H HCT）in staging of gastric cancer. Methods The study included 16 histopathologically proven GC patients. Plain scan and triphasic incremental helical CT were performed in all cases. Hypotonlc agent and water- filling method were used in 16 patients. Nonironic contrast medium was administrated with a power injector at the flow rate of 3ml/s. The triphasic spiral scans were obtained at 25s （arterial - dominant phase）, 80s （portal venous- dominant phase） and 180s （equilibrium phase） after the start of intravenous injection. The CT attenuation was measured both before and after enhancement. Histopathological slides were carefully prepared for the monoclonal antibody CD34 related antigen （F8RA） and polyclonal antibody anti - human vascular endothelial growth factor （VEGF） immunohistochemical staining and tumor microvessel density （MVD） and calculation of VEGF expression rate of tumor cells. The contrast- enhancement imaging features of GC lesions were correlatively studied with tumor MVD and VEGF expression. Results The accuracy of helical CT in determining the accuracy of the total TNM staging was 80. 5%. Peak attenuation（PA） of CT enhancement in GC lesions were 36 - 80HU （mean 60.16）, MVD were 13.15. There exists significant correlation between PA and MVD（P〈0. 01）. MVD and PA of strong positive VEGF expression group are evidently higher than those of negative and weak positive groups （0. 01〈P〈0.05 and 0.02〈P〈0.05 respectively）. The histological differentiation of GC was also positively correlated with VEGF expression rate. Conclusion The peak attenuation of CT enhancement reflects VEGF - related tumor angiogenesls in gastric carcinoma, therefore the malignancy and prognosis of GC is possible to be predicted preoperatively in CT images, which is of great value in planning surgical management and guiding the clinical therapy.
出处
《中国煤炭工业医学杂志》
2007年第8期876-877,共2页
Chinese Journal of Coal Industry Medicine
