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目的:探讨肾细胞癌螺旋CT灌注扫描参数与增殖细胞核抗原Ki-67的相关性。方法:选择24例经手术病理证实肾细胞癌患者与15例健康自愿者,行肾区CT平扫后选择经肿瘤的最大层面或正常肾脏选肾门平面为靶平面再行同层动态增强扫描,经过灌注软件处理分析,分别获得肾癌组织及双侧肾皮质的血流量(BF)、相对血容比(rBV)、平均通过时间(TTP)、通透性(Pm)及时间密度曲线(TDC图)。24例肿瘤组织切片采用免疫组化方法(SP法)检测肾肿瘤Ki-67的表达。将所获灌注参数与免疫组化指标进行比较研究。结果:①各级别肾细胞癌间及肾细胞癌与正常肾皮质BF、rBV、Pm均有显著性差异。各级别肾细胞癌间及肾细胞癌与正常肾皮质TTP无显著性意义;②各级别肾细胞癌间Ki-67表达均有显著性意义;③CT灌注参数中,BF、rBV、Pm与肾细胞癌Ki-67有明显相关关系;TTP与Ki-67间无显著相关性。结论:MSCT灌注成像能定量检测肾细胞癌血流灌注和血管通透性改变,有助于推测肾细胞癌的术前分级,评价肿瘤细胞增殖状态,为术前诊断及治疗提供依据。
Objective: To investigate the relationship between spiral CT perfusion scanning and Ki-67 in renal cell carcinoma. Methods: Twenty-four patients with pathologically confirmed renal cell carcinoma and 15 healthy volunteers were enrolled in this study. The maximum level of tumor selected by CT scan of the kidney area or the level of the selected renal tubules in the normal kidney as the target plane were dynamically scanned by the same layer (BF), relative blood volume ratio (rBV), mean transit time (TTP), permeability (Pm), and time-density curve of renal cell carcinoma and bilateral renal cortex were obtained through perfusion software analysis TDC chart). Immunohistochemistry (SP method) was used to detect the Ki-67 expression in renal tumors in 24 cases of tumor tissue. The perfusion parameters and immunohistochemical parameters were compared. Results ① There were significant differences in BF, rBV and Pm between renal cell carcinoma and renal cell carcinoma and normal renal cortex at all levels. The levels of Ki-67 in all grades of renal cell carcinoma, renal cell carcinoma and normal renal cortex had no significant difference. (2) The expression of Ki-67 in all grades of renal cell carcinoma was significantly different. (3) In CT perfusion parameters, BF, rBV, Cancer Ki-67 has a clear correlation; there is no significant correlation between TTP and Ki-67. Conclusion: MSCT perfusion imaging can quantitatively detect the changes of blood perfusion and vascular permeability of renal cell carcinoma, which is helpful to predict the preoperative grade of renal cell carcinoma and evaluate the proliferation status of the tumor cells and provide the basis for preoperative diagnosis and treatment.