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目的 利用 4层螺旋CT动态增强技术定量评价不同性质的明显强化孤立肺结节的血流模式并初步评价血管内皮生长因子 (VEGF)表达阳性的孤立性肺腺癌血管生成与血流模式定量CT参数的相关性。方法 78例孤立明显强化肺结节 (直径≤ 4cm ,6 8例恶性 ,10例活动性炎性 ) ,行多层螺旋CT(MSCT)动态增强 (以 4ml/s的流率注入对比剂 )。记录孤立肺结节增强前后各时相的CT值并计算强化值、灌注值 ,结节 主动脉强化值比。灌注值等于时间 密度曲线最大斜率除以主动脉强化值。其中 30例VEGF表达阳性的肺腺癌患者用免疫组织化学测定微血管密度 (MVD)并标定VEGF ,评价肺腺癌血流模式定量CT参数 (强化值、灌注值、结节 主动脉强化值比及平均通过时间 )与MVD的相关性。结果 恶性结节强化值 (35 79± 10 76 )HU与活动性炎性结节 (39 76± 4 5 9)HU差异无显著意义 (t=1 14 8,P =0 2 5 5 )。恶性结节的结节 主动脉强化值比 (14 2 7± 4 37) %及灌注值 (3 0 2±0 96 )ml-1·min-1·kg-1均低于活动性炎性结节 (18 5 1± 2 71) % ,(6 34± 4 39)ml-1·min-1·kg-1(t =2 978,P =0 0 0 4 ;t=5 5 90 ,P <0 0 0 0 1)。VEGF表达阳性的肺腺癌强化值 (33 0 6± 13 5 7)HU、结节 动脉强化值比 (14 2 5± 4 92 ) %及?
Objective To quantitatively evaluate the blood flow pattern of isolated pulmonary nodules with different properties by using 4-slice spiral CT dynamic enhancement technique and to evaluate the expression of vascular endothelial growth factor (VEGF) in solitary pulmonary adenocarcinoma with angiogenesis and flow pattern quantitatively Correlation of parameters. Methods Totally 78 cases of pulmonary nodules were significantly isolated (diameter ≤ 4 cm, 68 with malignancy and 10 with active inflammation). MSCT was performed dynamically (contrast injection at 4 ml / s). The CT values of the isolated lung nodules before and after the enhancement were recorded and the intensified values, perfusion values, and nodal aortic enhancement ratios were calculated. The perfusion value is equal to the maximum slope of the time density curve divided by the aortic fortification value. Among 30 cases of lung adenocarcinoma with positive VEGF expression, the microvessel density (MVD) was measured by immunohistochemistry and VEGF was quantified. The quantitative CT parameters of blood flow pattern of lung adenocarcinoma (enhanced value, perfusion value, ratio of enhancement of nodal aorta, Mean transit time) and MVD. Results There was no significant difference between HU (35 79 ± 10 76) HU and active inflammatory nodules (39 76 ± 459) HU (t = 1 14 8, P = 2555). Malignant nodules had a lower nodular aortic enhancement ratio (14 2 7 ± 4 37)% and a perfusion value (302 ± 0 96) ml -1 min -1 · kg -1 than active inflammatory nodules (18 51 ± 2 71)%, (6 34 ± 4 39) ml-1 min -1 kg -1 (t = 2 978, P = 0 0 04, t = 5 5 90, P < 0 0 0 0 1). The positive expression of VEGF in lung adenocarcinoma was significantly higher than that in lung adenocarcinoma (33 0 6 ± 13 57) HU, nodular arteries enhanced (14 25 ± 4 92)% and