MR 灌注成像在前列腺疾病診斷中作用的
初步探討
張繼斌 沈鈞康 許建銘 須同祿 李曉兵 劉仁堅 湯建英 陸之安
【摘要】 目的 探討MR 灌注成像在前列腺良惡性病變中的初步應用, 評價血管內皮生長因子
( VEGF) 和微血管密度( MVD) 與MR 灌注成像各指標的關系。方法 對臨床診斷為前列腺疾病的
70 例患者, 其中良性前列腺增生( BPH) 42 例, 前列腺癌( PCa ) 28 例, 進行MR 灌注成像, 并對標本進
行免疫組織化學檢測; 分析病變的灌注曲線最大線性斜率( SSmax) 、T*
2 弛豫率( ΔR*
2 peak) 與免疫組
織化學檢查結果( VEGF、MVD) 的相關性。結果 ( 1) BPH 組增生結節灌注曲線的SSmax 及
ΔR*
2 peak 分別為: 33. 5 ±3. 1、1. 5 ±0. 1; PCa 組癌灶灌注曲線的SSmax 及ΔR*
2 peak 分別為: 58. 4 ±
4. 7、3. 1 ±0. 5, 兩者之間差異有統計學意義( t 值分別為2. 13、2. 29, P 值均< 0. 05) ; PCa 組高、中、低
分化腺癌的SSmax 分別為: 52. 3 ±3. 4、56. 4 ±4. 3、60. 7 ±5. 2, 差異有統計學意義( F = 132. 04, P <
0. 05) , ΔR*
2 peak 分別為: 2. 9 ±0. 4、3. 1 ±0. 5、3. 2 ±0. 7, 差異有統計學意義( F = 114. 82, P < 0. 05) 。
( 2) BPH 組VEGF 陽性9 例, MVD 值為22. 76 ±6. 54; PCa 組VEGF 陽性為24 例, MVD 值為71. 38 ±
9. 17; PCa 的VEGF 和MVD 的表達水平明顯高于BPH 患者( χ2
= 27. 86, P < 0. 01; t = 20. 4, P <
0. 01) , PCa、BPH 的VEGF 表達與MVD 表達呈正相關性( P < 0. 01) ; 灌注加權成像( PWI) 參數
SSmax、ΔR*
2 peak 與VEGF、MVD 具有相關性( P < 0. 01) 。結論 PWI 的有關指標( SSmax、ΔR*
2 peak)
與MVD 和VEGF 的表達水平相關, 有可能為前列腺疾病良惡性的鑒別提供信息。
【關鍵詞】 前列腺增生; 前列腺腫瘤; 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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