【作者】 李丽艳；

【导师】 周顺科；

【作者基本信息】 中南大学 ， 影像医学与核医学， 2008， 硕士

【摘要】 第一部分MSCT灌注成像在乳腺癌诊断中的应用研究目的:研究乳腺癌、乳腺良性实质肿瘤及乳腺癌旁正常组织的多层螺旋CT(multidetector-row spiral computed tomography,MSCT)灌注成像特征。方法:38例病人中,乳腺癌27例,乳腺良性实质肿瘤11例。先行常规乳腺MSCT平扫,选定灌注扫描层面,以6 ml/s速度注射300 mgI/ml非离子型碘造影剂50 ml,在病变部位行同层动态扫描,进行图像后处理,得到彩色灌注图及各感兴趣区的时间-密度曲线(Time-density curve,TDC)和灌注参数。采用x~2检验、独立样本t检验、配对t检验进行统计学处理,对乳腺癌、乳腺良性实质肿瘤和乳腺癌旁正常组织的MSCT灌注成像TDC曲线和最大密度投影(maximum intensity projection,MIP)、增强平均值(average value,AV)、血流量(blood flow,BF)、血容量(blood volume,BV)、灌注起始时间(time to start,TTS)、灌注峰值时间(time to peak,TTP)、血管表面通透性(permeability surface,PS)和Patlak血容量(Patlakblood volume,PBV)等灌注参数进行比较。结果:癌旁正常乳腺组织TDC曲线均为为平坦型,TDC曲线为流出型和平台型的乳腺肿瘤分别有76.47%、71.43%为乳腺癌,而TDC曲线为流入型的肿瘤85.72%为良性实质肿瘤。乳腺癌的BF、BV、PS、PBV分别为63.934±36.918 ml/100ml/min、8.471±3.440 ml/100ml、19.522±10.873 ml/100ml/min、13.293±10.216 ml/100ml,均高于良性实质肿瘤及癌旁正常乳腺组织,而TTS、TTP各组之间差异没有统计学意义。最大径2.0 cm以上的乳腺癌中心带AV、BF、BV、PBV低于边缘带,良性实质肿瘤中心带BF、BV、PBV高于边缘带,余灌注参数差别无统计学意义。结论:乳腺癌、乳腺良性实质肿瘤、癌旁正常乳腺组织CT灌注特征不同,MSCT灌注扫描对乳腺癌的诊断、鉴别诊断、活检定位具有重要价值。第二部分乳腺癌MSCT灌注成像与血管生成的相关性研究目的:探讨乳腺癌MSCT灌注成像与微血管生成的关系。材料和方法:同第一部分病例,乳腺癌标本28个,乳腺良性实质肿瘤标本25个,癌旁组织标本26个(均取自乳腺癌切除标本中无浸润的癌旁乳腺组织)与乳腺癌标本配对研究。采用“热点”法计数MVD,低倍镜下寻找热点,高倍镜(~*400)下计数3个视野最高数目的微血管数,以其平均数表示;VEGF表达阳性采用染色强度与阳性细胞百分比分值之和判定结果。统计分析采用SPSS11.5统计软件,推断乳腺癌各灌注参数与MVD有无相关性,描绘“散点图”并计算相关系数。结果:乳腺肿瘤组织内MVD与VEGF统计学上呈正相关,等级相关系数为0.815。乳腺癌组织的MVD、VEGF均高于乳腺良性实质肿瘤及癌旁正常乳腺组织,差别有统计学意义。CT灌注TDC曲线流出型、流入型、平台型、平坦型四种类型乳腺肿瘤组织的MVD、VEGF的比较,差别有统计学意义,流出型和平台型乳腺肿瘤组织的MVD、VEGF高于流入型和平坦型。乳腺癌组织MSCT灌注参数MIP、AV、BF、BV、PS、PBV与MVD统计学上呈正相关,相关系数分别为0.441,0.457,0.501,0.493,0.523,0.473。结论:乳腺肿瘤MVD与其VEGF有密切关系,乳腺癌与良性实质肿瘤血管形成情况不同。MSCT灌注成像可以较好地反映乳腺癌的血管生成情况,各灌注参数与MVD有较好的相关性,MSCT灌注成像是一种方便、敏感、准确的非损伤性检测乳腺癌血管生成的方法。更多还原

【Abstract】 Objective:To study the characters of Multidetector-Row Spiral Computed Tomography(MSCT)perfusion imaging in Breast cancer, breast benign tumors and normal breast.Methods:There were 38 patients including 27 breast cancer and 11 benign breast tumor.A conventional breast MSCT scan was obtained as a routine to locate the breast lesions.Dynamic scans were performed at the location of the lesions with 50 ml of nonionic contrast administration (300 mgI/ml)at the speed of 6 ml/s.Data postprocessing was performed on Siemens workstation using tumor analyzing software in the package of Body Perfusion.Pseudo-color perfusion images were gained,so as to the time-density curve(TDC)and perfusion parameters by region of interest(ROI)evaluation.Chi-Square Tests,Independent Samples T-Test and Paired Samples T-Test were applied to compare the TDC type and perfusion parameter values of breast cancer,breast benign tumors and normal breast.Perfusion parameters include maximum intensity projection(MIP),average value(AV),blood flow(BF),blood volume(BV), time to start(TTS),time to peak(TTP),permeability surface(PS),Patlak blood volume(PBV).Results:The TDC of normal breast tissues were flat-type.76.47%, 71.43%breast tumors with outflow-type or platform-type TDC were breast cancer,while 85.72%breast tumors with inflow-type were benign. The means of BF,BV,PS and PBV in breast cancer were 63.934±36.918 ml/100ml/min,8.471±3.440 ml/100ml,19.522±10.873 ml/100ml/min, 13.293±10.216 ml/100ml respectively.The means of BF,BV,PS and PBV of breast cancer were higher than those of benign breast tumor and normal breast,while the means of TTP and TTS among breast cancer, benign tumor and normal breast have no significant difference.The means of AV,BF,BV and PBV of center zone were lower than those of boundary zone in breast cancer,while the means of BF,BV and PBV of center zoon were higher than those of boundary zone in benign breast tumors.Conclusion:There are different MSCT perfusion characters among breast cancer,benign breast tumor and nomal breast,which are helpful to differentiate the breast cancer or benign breast tumors and to orientate in biopsy.PartⅡ:Study on relation between MSCT perfusion imaging and angiogenesis in breast cancerObjective:To research the relation between MSCT perfusion imaging and angiogenesis of breast cancer.Materials and Methods:The cases in this part were the same with PartⅠ.The microvessel density(MVD)and vascular endothelial growth factor(VEGF)of the tissues from 28 breast cancer,26 paracarcinoma breast tissues and 25 benign breast tumors were detected by immunohistochemistry technology."Hotpoint" was used to count the MVD,the cumulation of staining intensity and positive cell ratio was used to count VEGF.The CT perfusion parameter values and MVD, VEGF were put in SPSS11.5 to gain the "scatterplot graph" and the correlation coefficients.Results:Expression of MVD and VEGF were detected in tissues of breast cancer,benign breast tumors and paracarcinoma breast tissues. MVD and VEGF of breast tumor tissues had positive relation statistically and the Spearman rank correlation coefficient was 0.815.Expression of MVD and VEGF of breast cancer tissue were statistically higher than those of benign breast tumors and paracarcinoma breast tissues.The means of MVD and VEGF in outflow-type and platform-type time-density curve were statistically higher than that in inflow-type and flat-type of breast tumors.MIP,AV,BF,BV,PS and PBV of breast cancer had positive relation statistically with MVD,the Pearson correlation coefficients were 0.441,0.457,0.501,0.493,0.523,0.473.Conclusion:MVD and VEGF of breast tumor tissue have positive relation statistically.Breast cancer and benign breast tumor have different angiogenesis.Multidetector-Row Spiral CT perfusion imaging can detect and represent the angiogenesis of breast cancer.The perfusion parameter values have close relation with MVD of breast cancer.The technology is a convenient,sensitive and correct method to detect breast cancer angiogenesis.更多还原