Value of gastric contrast-enhanced ultrasound combined with intravenous contrast-en-hanced ultrasound in evaluating the invasion and angiogenesis of gastric cancer
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摘要:
目的 分析胃超声造影联合经静脉超声造影评估胃癌侵袭及新生血管的价值。 方法 选取医院2020年1月~2021年12月收治的82例胃癌患者,所有患者均在手术治疗前1周内完成胃超声造影联合经静脉超声造影(双重超声造影)检查,取术中病理组织,免疫组化法检测肿瘤微血管密度。以手术病理检查结果作为“金标准”,分析双重超声造影在评估胃癌T分期中的价值,Pearson相关分析胃癌病变区与正常胃壁时间-强度曲线参数与微血管密度之间的关系。 结果 手术病理检查证实82例胃癌患者中T1、T2、T3及T4a、T4b期分别有23例、26例、18例、9例及6例。以手术病理检查结果作为“金标准”,双重超声造影在术前诊断胃癌T分期中的总准确率为78.05%。胃癌病变组织超声造影参数基础强度、达峰时间以及灌注时间水平均低于正常胃壁组织,峰值强度及增强强度水平均高于正常胃壁组织,差异有统计学意义(P < 0.05)。两组达到时间水平的差异无统计学意义(P > 0.05)。相关性分析显示,胃癌组织内微血管密度表达量与超声造影参数基础强度、达峰时间以及灌注时间均呈负相关关系(P < 0.05),与峰值强度及增强强度均呈正相关关系(P < 0.05)。 结论 双重超声造影在胃癌术前分期中具有良好应用价值,其时间-强度曲线参数在提示肿瘤内部新生血管中也具有一定的价值,有望成为胃癌术前病前判断的有效参考。 Abstract:Objective To investigate the value of gastric contrast-enhanced ultrasound combined with intravenous contrast-enhanced ultrasound in evaluating the invasion and angiogenesis of gastric cancer. Methods Eighty-two patients with gastric cancer admitted to the hospital from January 2020 to Decembe 2021 were enrolled. All patients received gastric with intravenous contrast-enhanced ultrasound (double contrast-enhanced ultrasound) examinations one week before operation. The pathological tissues were collected during surgery, tumor microvessel density was detected by immunohistochemistry. Taking the pathological examination results as "gold standard", the value of double contrast-enhanced ultrasound in evaluating the T-stage of gastric cancer was analyzed. The relationship between time intensity curve parameters and microvessel density of gastric cancer lesions and normal gastric wall tissues was discussed by Pearson correlation analysis. Results Surgical pathological examination confirmed that 82 gastric cancer patients included 23 patients at stage T1, 26 at stage T2, 18 at stage T3, 9 at stage T4a and 6 at stage T4b. Taking the results of surgical pathological examination as the "gold standard", the total accuracy of dual-contrast ultrasound in the preoperative diagnosis of T-stage of gastric cancer was 78.05%. The baseline intensity, time to peak and infusion time of gastric cancer lesions were significantly lower than those of normal gastric wall tissues, while the peak intensity and enhanced intensity were significantly higher than those of normal gastric wall tissues (P < 0.05). No significant difference was found in arrival time between two tissues (P > 0.05). Correlation analysis showed that microvessel density in gastric cancer tissue was negatively correlated with the ultrasound contrast parameters baseline intensity, time to peak and infusion time (P < 0.05), and positively correlated with peak intensity and enhanced intensity (P < 0.05). Conclusion Double contrast-enhanced ultrasound has a good application value in the preoperative staging of gastric cancer. Its time intensity curve parameters are also of certain value in the indication of tumor angiogenesis, which is expected to be an effective tool in the preoperative assessment of gastric cancer. -
表 1 双重超声造影在术前诊断胃癌T分期中的价值
Table 1. Value of double contrast-enhanced ultrasound in evaluat-ing the T-stage of gastric cancer
Surgical staging Cases (n) Gastric contrast-enhanced ultrasound combined with intravenous contrast-enhanced ultrasound [n(%)] T1 23 19(82.61) T2~3 44 32(72.73) T4a 9 7(77.78) T4b 6 6(100.00) Total 82 64(78.05) 表 2 胃癌病变组织与正常胃壁组织超声造影参数比较
Table 2. Comparison of contrast-enhanced ultrasound parameters between gastric cancer lesions and normal gastric wall tissues (n=82, Mean±SD)
Different tissues BI(dB) TTP(s) PI(dB) AT(s) EI(dB) Infusion time (s) Gastric cancer lesions 2.16±0.36 17.63±2.41 28.41±4.15 7.83±1.86 26.74±3.36 10.31±2.13 Normal gastric wall tissues 4.97±1.06 20.65±3.33 23.69±4.43 7.92±1.94 18.85±3.47 12.15±2.28 t 22.730 6.653 7.041 0.303 14.792 5.340 P < 0.001 < 0.001 < 0.001 0.762 < 0.001 < 0.001 BI: Baseline intensity; TTP: Time to peak; PI: Peak intensity; AT: Arrival time; EI: Enhanced intensity. 表 3 超声造影参数与MVD表达的相关性分析
Table 3. Correlation analysis between contrast- enhanced ultra-sound parameters and MVD
Parameters MVD r P BI -0.268 0.030 TTP -0.374 0.007 PI 0.685 <0.001 AT 0.074 0.814 EI 0.873 <0.001 Infusion time -0.243 0.034 MVD:Microvessel density -
[1] 马生君, 刘晔, 杨海龙, 等. 胃充盈超声检查与增强CT在提高胃癌患者术前T分期准确率中的应用[J]. 中国超声医学杂志, 2021, 37(8): 888-92. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGCY202108017.htm [2] 汤丽健, 潘晓洁, 张新成, 等. 胃超声造影及核磁共振在进展期胃癌术前TNM分期诊断的一致性分析[J]. 广西医科大学学报, 2021, 38 (8): 1563-8. https://www.cnki.com.cn/Article/CJFDTOTAL-GXYD202108016.htm [3] 赵小琪, 刘慧, 向红. 卵巢癌超声造影与血管生成拟态和MVD的相关性分析[J]. 中国医学影像技术, 2014, 30(12): 1792-6. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYXX201412011.htm [4] 王金宏, 许映斌, 林腾, 等. 双重超声造影在评价胃癌血管生成中的应用价值[J]. 中国医师杂志, 2018, 20(6): 812-5. [5] Gao LM, Wang F, Zheng Y, et al. Roles of fibroblast activation protein and hepatocyte growth factor expressions in angiogenesis and metastasis of gastric cancer[J]. Pathol Oncol Res, 2019, 25(1): 369- 76. doi: 10.1007/s12253-017-0359-3 [6] Li F, Meng GQ, Tan BB, et al. Relationship between HER2 expression and tumor interstitial angiogenesis in primary gastric cancer and its effect on prognosis[J]. Pathol Res Pract, 2021, 217: 153280. doi: 10.1016/j.prp.2020.153280 [7] 郭瑞, 邓得峰, 吴英, 等. 肝细胞肝癌的IVIM-DWI多定量参数与病理的相关性研究[J]. 国际医学放射学杂志, 2020, 43(2): 162-7. https://www.cnki.com.cn/Article/CJFDTOTAL-GWLC202002009.htm [8] 付佳, 唐磊, 李子禹, 等. CT区分SiewertⅡ型食管胃结合部腺癌cT3与cT4a: 国际抗癌联盟/美国癌症联合委员会(UICC/AJCC)第8版分期与国际胃癌协会(IGCA)第4版分期对照研究[J]. 中华胃肠外科杂志, 2018, 21(9): 1013-8. [9] 王国平, 徐丹丹, 陈胜民, 等. 胃窗超声造影与双重超声造影在胃癌分期及胃间叶源性肿瘤检出的临床价值[J]. 川北医学院学报, 2021, 36 (3): 320-3. https://www.cnki.com.cn/Article/CJFDTOTAL-NOTH202103011.htm [10] 杨伯文, 韩红. 超声双重造影用于胃癌术前T分期诊断的Meta分析[J]. 中国医学影像学杂志, 2019, 27(3): 225-9. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYYZ201903019.htm [11] 周礼, 邓磊, 刘姝妮, 等. 超声双重造影与超声内镜评估进展期胃癌新辅助化疗后再分期及周围组织侵犯的一致性分析[J]. 临床超声医学杂志, 2022, 24(3): 192-6. https://www.cnki.com.cn/Article/CJFDTOTAL-LCCY202203007.htm [12] 邹蕾, 陈竹. 超声双重造影评估胃癌良恶性病变的应用价值[J]. 中国肿瘤临床与康复, 2020, 27(11): 1363-5. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZK202011031.htm [13] 庞娟娟, 张永凤, 王雪. 双重超声造影评估胃癌细胞侵袭及血管生成的价值[J]. 临床超声医学杂志, 2021, 23(3): 179-82. https://www.cnki.com.cn/Article/CJFDTOTAL-LCCY202103007.htm [14] 李小溪, 石宛灵, 康利克, 等. 双重超声造影联合超声内镜在胃癌患者术前TNM分期的应用价值[J]. 中国超声医学杂志, 2021, 37(11): 1249-52. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGCY202111015.htm [15] 江华, 刘发生, 冯晓曦, 等. 对比增强超声造影联合多层螺旋CT评估老年胃癌患者术前TNM分期[J]. 现代消化及介入诊疗, 2021, 26 (5): 632-6. https://www.cnki.com.cn/Article/CJFDTOTAL-XDXH202105021.htm [16] 方苑仲, 刘志红, 张荣. 胃癌血流灌注状态与血清血管新生指标的相关性[J]. 世界华人消化杂志, 2020, 28(9): 347-51. https://www.cnki.com.cn/Article/CJFDTOTAL-XXHB202009008.htm [17] 李婷, 李国梁. 超声双重造影在胃癌检查中的应用及其与微血管密度的相关性[J]. 浙江创伤外科, 2021, 26(5): 970-2. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJCW202105086.htm [18] Tao XY, Cheng LL, Li YJ, et al. Expression of CRYAB with the angiogenesis and poor prognosis for human gastric cancer[J]. Medicine, 2019, 98(45): e17799. doi: 10.1097/MD.0000000000017799 [19] Zhang YD, Qu H. Expression and clinical significance of aquaporin- 1, vascular endothelial growth factor and microvessel density in gastric cancer[J]. Medicine, 2020, 99(36): e21883. doi: 10.1097/MD.0000000000021883 [20] 郭嘉欣, 李梦琪, 尚静, 等. 硫酸右旋糖苷通过下调血管内皮生长因子/血管内皮生长因子受体2表达和M2型巨噬细胞浸润抑制胃癌血管生成的研究[J]. 实用医学杂志, 2020, 36(17): 2365-70. https://www.cnki.com.cn/Article/CJFDTOTAL-SYYZ202017010.htm [21] 刘霞, 高立永, 张弛, 等. 胃癌组织中基质金属蛋白酶2蛋白表达及微血管密度与患者临床病理特征的关系[J]. 肿瘤研究与临床, 2020, 32(6): 400-4. [22] 门慧, 谈顺. EGFL6在胃癌血管生成中的作用[J]. 临床与实验病理学杂志, 2021, 37(10): 1183-8. https://www.cnki.com.cn/Article/CJFDTOTAL-LSBL202110007.htm [23] 吴玮, 阳建军, 范慧慧, 等. 超声双重造影在胃癌肝转移新辅助化疗疗效评估中的应用价值[J]. 中国医药导报, 2019, 16(10): 142-5. https://www.cnki.com.cn/Article/CJFDTOTAL-YYCY201910038.htm