MR 灌注成像在前列腺疾病诊断中作用的初步探讨

MR 灌注成像在前列腺疾病诊断中作用的
初步探讨
张继斌 沈钧康 许建铭 须同禄 李晓兵 刘仁坚 汤建英 陆之安
【摘要】 目的 探讨MR 灌注成像在前列腺良恶性病变中的初步应用, 评价血管内皮生长因子
( VEGF) 和微血管密度( MVD) 与MR 灌注成像各指标的关系。方法 对临床诊断为前列腺疾病的
70 例患者, 其中良性前列腺增生( BPH) 42 例, 前列腺癌( PCa ) 28 例, 进行MR 灌注成像, 并对标本进
行免疫组织化学检测; 分析病变的灌注曲线最大线性斜率( SSmax) 、T*
2 弛豫率( ΔR*
2 peak) 与免疫组
织化学检查结果( VEGF、MVD) 的相关性。结果 ( 1) BPH 组增生结节灌注曲线的SSmax 及
ΔR*
2 peak 分别为: 33. 5 ±3. 1、1. 5 ±0. 1; PCa 组癌灶灌注曲线的SSmax 及ΔR*
2 peak 分别为: 58. 4 ±
4. 7、3. 1 ±0. 5, 两者之间差异有统计学意义( t 值分别为2. 13、2. 29, P 值均< 0. 05) ; PCa 组高、中、低
分化腺癌的SSmax 分别为: 52. 3 ±3. 4、56. 4 ±4. 3、60. 7 ±5. 2, 差异有统计学意义( F = 132. 04, P <
0. 05) , ΔR*
2 peak 分别为: 2. 9 ±0. 4、3. 1 ±0. 5、3. 2 ±0. 7, 差异有统计学意义( F = 114. 82, P < 0. 05) 。
( 2) BPH 组VEGF 阳性9 例, MVD 值为22. 76 ±6. 54; PCa 组VEGF 阳性为24 例, MVD 值为71. 38 ±
9. 17; PCa 的VEGF 和MVD 的表达水平明显高于BPH 患者( χ2
= 27. 86, P < 0. 01; t = 20. 4, P <
0. 01) , PCa、BPH 的VEGF 表达与MVD 表达呈正相关性( P < 0. 01) ; 灌注加权成像( PWI) 参数
SSmax、ΔR*
2 peak 与VEGF、MVD 具有相关性( P < 0. 01) 。结论 PWI 的有关指标( SSmax、ΔR*
2 peak)
与MVD 和VEGF 的表达水平相关, 有可能为前列腺疾病良恶性的鉴别提供信息。
【关键词】 前列腺增生; 前列腺肿瘤; 磁共振成像; 灌注
Pr eliminar y application of MR per fusion-weight ed imaging in the benign and maligna nt pr ostate
diseases ZHANG J i-bin* , SHEN Jun-kang, XU J ia n-ming, XU Tong-lu, LI Xiao-bing, LIU Ren-jian,
TANG J ia n-ying, LU Zhi-an. * Department of Radiology, Headquater of Municipl Hospita l Affilicated to
Nanjing Medical Unirersity, Suzhou 215002, China
Corresponding author: SHEN Jun-kang, Email: junkangsh@yahoo. com
【Abstra ct 】 Objective To explore the preliminary application of perfusion-weighted MR imaging in
the benign and malignant prostate diseases, and evaluate the correlation of PWI features with vascular
endothelial growth factor ( VEGF) and microvessel density ( MVD) . Met hods Seventy consecutive patients
who were diagnosed clinically for the prostatic diseases, including forty-two cases with benign prostate
hyperplasia and twenty-eight cases with prostate cancer proved pathologically, were examined by PWI. MVD
and VEGF were stained with immuno-histochemical methods. Some parameters of PWI, including the
steepest slope of signal intensity-time curve ( SSmax) and ΔR*
2 peak at lesions, were put more analyses.
Correlation analysis was used to determine the relation between the results of PWI and that of immunohistochemistry.
Results ( 1) In the benign prostate hyperplasia, SSmax and ΔR*
2 peak of perfusion curve
were 33. 5 ±3. 1 and 1. 5 ±0. 1 respectively. However, in the prostate cancer the SSmax and ΔR*
2 peak were
58. 4 ±4. 7 and 3. 1 ±0. 5 respectively. There were statistically significant difference ( t = 2. 13, 2. 29, P <
0. 05 ) between them. SSmax of perfusion curve in the prostate cancer ( high differentiation, middle
differentiation, low differentiation ) was 52. 3 ±3. 4, 56. 4 ±4. 3, 60. 7 ±5. 2 respectively, it had statistical
differences in three groups( F = 132. 04, P < 0. 05 ) . ΔR*
2 peak of perfusion curve was 2. 9 ±0. 4, 3. 1 ±
0. 5, 3. 2 ±0. 7 respectively, it also had statistical differences in three groups ( F = 114. 82, P < 0. 05) . ( 2)
In the benign prostate hyperplasia, positive and negative VEGF expression was 9 cases and 33 cases
respectively, MVD average value was 22. 76 ±6. 54. In the prostate cancer, positive and negative VEGF
expression was 24 cases and 4 cases respectively, MVD average value was 71. 38 ±9. 17. The VEGF and
MVD expression of 28 PCa patients were significantly higher than those of 42 BPH patients( χ2
= 27. 86, P <
0. 01; t = 20. 4, P < 0. 01 ) . MVD expression of PCa and BPH showed an positive association with VEGF
expression( P < 0. 01 ) . On PWI, SSmax and ΔR*
2 peak showed an association with MVD and VEGF
expression( P < 0. 01) . Conclusion On PWI, SSmax and ΔR*
2 peak can reflect MVD and VEGF expression
levels in the benign and malignant prostate diseases and might be implied the tumor angiogenesis so as to
distinguish benign from malignant and provide the important information for the surgeon to diagnose and treat
the prostatic diseases.
【Key wor ds】 Prostate hyperplasia; Prostate neoplasms; Magnetic resonance imaging; Perfusion

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