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[目的]探讨多层螺旋CT(MSCT)灌注成像在肾肿瘤诊断中的价值。[方法]59例肾肿瘤行MSCT灌注扫描,应用perfusion2软件包计算血流量(BF)、血容量(BV)、表面通透性(PS)及平均通过时间(MTT),同时检测肾肿瘤及肿瘤旁正常组织中血管内皮生长因子(VEGF)的表达及微血管密度(MVD)。[结果]59例肾肿瘤术后病理证实为肾癌48例,肾盂癌6例,肾血管平滑肌脂肪瘤5例。在不同级别的肾细胞癌中,其灌注参数BF、BV和PS均明显低于正常肾皮质(P<0.01),且高级别的肾癌灌注参数BF、BV和PS均明显高于低级别的肾癌(P<0.01)。肾血管平滑肌脂肪瘤和肾盂癌的灌注值均明显低于肾癌,有显著性差异(P<0.01)。肾癌的BF、BV、PS值与肿瘤的VEGF表达呈显著正相关(P<0.01),MTT值与VEGF表达呈显著负相关(P<0.01)。[结论]MSCT灌注成像能定量评价肿瘤血管生成,血管灌注及血管通透性改变,有助于肾细胞癌的术前分级,并在肾肿瘤的鉴别诊断方面具有一定的临床应用价值。
[Objective] To investigate the value of multi-slice spiral CT (MSCT) perfusion imaging in the diagnosis of renal tumors. [Methods] Fifty-nine patients with renal tumors underwent MSCT perfusion scan. The perfusion2 software package was used to calculate the blood flow volume (BF), blood volume (BV), surface permeability (PS) and mean transit time (MTT) Next to the normal tissue expression of vascular endothelial growth factor (VEGF) and microvessel density (MVD). [Results] The pathological results of renal cell carcinoma in 59 cases were confirmed to be renal cell carcinoma in 48 cases, renal pelvic carcinoma in 6 cases and renal angiomyolipoma in 5 cases. In different grades of renal cell carcinoma, perfusion parameters BF, BV and PS were significantly lower than that of normal renal cortex (P <0.01), and high grade renal cell carcinoma perfusion parameters BF, BV and PS were significantly higher than the low-grade Kidney cancer (P <0.01). Renal angiomyolipoma and renal pelvic cancer perfusion values were significantly lower than that of renal cell carcinoma, there was a significant difference (P <0.01). The BF, BV and PS values of renal cell carcinoma were positively correlated with the expression of VEGF (P <0.01). The MTT value was negatively correlated with the expression of VEGF (P <0.01). [Conclusion] MSCT perfusion imaging can quantitatively evaluate the changes of tumor angiogenesis, vascular perfusion and vascular permeability and contribute to the preoperative classification of renal cell carcinoma, and has certain clinical value in the differential diagnosis of renal tumors.