超声造影评估膀胱癌病理分级及其与微血管的相关性研究

发布时间：2018-05-24 19:37

本文选题：膀胱肿瘤 + 乳头状瘤　；参考：《南昌大学》2017年硕士论文

【摘要】：目的:1.探讨常规超声联合超声造影(contrast-enhanced ultrasound,CEUS)鉴别膀胱内翻性乳头状瘤(inverted papilloma of bladder,IPB)与膀胱尿路上皮癌(papillary urothelial carcinoma,PUC)的应用价值。2.探讨低级别膀胱尿路上皮癌(low grade papillary urothelial carcinoma,LGPUC)和高级别膀胱尿路上皮癌(high grade papillary urothelial carcinoma,HGPUC)CEUS时间-强度曲线(time intensity curve,TIC)定量参数与微血管密度(microvessel density,MVD)的相关性。方法:1.回顾性分析自2014年9月至2016年11月南昌大学第一附属医院经病理诊断为IPB患者32例和PUC患者57例的常规超声和CEUS表现。采用QLAB分析软件获得IPB和PUC的TIC参数,包括上升时间(rise time,RT)、平均渡越时间(mean transit time,MTT)、峰值强度(peak intensiy,PI)、半洗漱时间(time from peak to one half,TPH)、达峰时间(time to peak,TP)、上升斜率(wash in slope,WIS)、半降支斜率(semi-descending slope,DS)绝对值,并进行统计学分析得到IPB和PUC的CEUS特征表现。2.回顾性分析自2013年2月至2016年11月南昌大学第一附属医院术前行CEUS检查且经手术或膀胱镜活检病理诊断为LGPUC患者55例和HGPUC患者50例,术前均行CEUS检查并利用QLAB分析软件获得TIC定量参数,对手术标本进行抗CD34因子免疫组化染色测量MVD,分析两组CEUS TIC定量参数与MVD的相关性。结果:1.在常规超声方面,IPB及PUC两组肿块的位置、形态、长径/基底宽(Longitudinal/Transverse diame-terratio,L/T)及其内血流情况差异均有统计学意义(P0.05);在CEUS定量参数中,峰值强度(PI)、半降支斜率(DS)、峰值强度减半时间(TPH)、达峰时间(TP)比较,差异均有统计学意义(P0.05),上升时间(RT)、平均渡越时间(MTT)、上升斜率(WIS)比较差异无统计学意义(P0.05)。2.在手术后病理证实55例LGPUC和50例HGPUC的MVD中,HGPUC组的MVD(51.03±20.16)明显高于LGPUC组(41.39±16.65)(P0.05);LGPUC和HGPUC的TPH与MVD呈正相关(r=0.86,P0.05),DS与MVD呈负相关(r=-0.76,P0.05)。结论:1.CEUS定量分析可较好地反映IPB和PUC的血流灌注情况,常规超声及CEUS在IPB和PUC的鉴别诊断中具有较高的临床价值。2.CEUS在鉴别LGPUC和HGPUC中具有一定的临床价值。PUC中CEUS定量参数与MVD有一定的相关性,提示CEUS在一定程度上能较好的反映PUC的MVD。CEUS将可作为一项在活体上可重复、相对无创、快捷地评估肿瘤血管生成的新型技术,可为PUC的临床诊断、个性化治疗及预后判断提供更多的信息。
[Abstract]:Purpose 1. To evaluate the value of conventional contrast-enhanced ultrasound (CEUSS) in differentiating inverted papilloma of bladderma from papillary urothelial carcinoma of bladder. To investigate the correlation between the quantitative parameters of low grade papillary urothelial carcinoma of urinary tract (LGPUC) and high grade papillary urothelial carcinoma of urinary tract (HGPU CCEUS) and microvessel density (MVD). Method 1: 1. From September 2014 to November 2016, 32 patients with IPB and 57 patients with PUC diagnosed by pathology in the first affiliated Hospital of Nanchang University were analyzed retrospectively. The TIC parameters of IPB and PUC were obtained by using QLAB analysis software, including rising time, mean transit time and MTT, peak intensity and peak intensity, half washing time and half from peak to one, peak time to peak-QLAB, rising slope wash in slopewise, semi-descending slope, absolute value of semi-descending slope. The CEUS characteristics of IPB and PUC were obtained by statistical analysis. 2. 2. From February 2013 to November 2016, 55 patients with LGPUC and 50 patients with HGPUC were examined by CEUS and diagnosed by operation or cystoscopic biopsy in the first affiliated Hospital of Nanchang University from February 2013 to November 2016. The quantitative parameters of TIC were obtained by QLAB software before operation, and the correlation between CEUS TIC quantitative parameters and MVD was analyzed by immunohistochemical staining of anti-CD34 factor. The result is 1: 1. There were significant differences in the location, shape, long diameter / basal width of long diameter / basal width Transverse diamterratiol / T) and internal blood flow between the two groups in conventional ultrasound, and in the quantitative parameters of CEUS, there was no significant difference between the two groups (P < 0.05). There were significant differences in peak intensity (Pi), semi-descending slope (DSN), peak intensity half time (TPH) and peak time (TP). There was no significant difference between peak intensity and peak intensity (P 0.05), average transit time (MTT), and rise slope (wise) were not significantly different (P 0.05 路2). In the MVD of 55 cases of LGPUC and 50 cases of HGPUC, the MVD(51.03 卤20.16 in HGPUC group was significantly higher than that in LGPUC group (41.39 卤16.65) and TPH in HGPUC was positively correlated with MVD in 55 cases of LGPUC and 50 cases of HGPUC. Conclusion: 1. The quantitative analysis of CEUs can better reflect the blood flow perfusion of IPB and PUC. Conventional ultrasound and CEUS have high clinical value in differential diagnosis of IPB and PUC. 2.CEUS has certain clinical value in differentiating LGPUC and HGPUC. The quantitative parameters of CEUS in LGPUC and HGPUC have certain correlation with MVD. The results suggest that MVD.CEUS, which can reflect PUC to a certain extent, can be used as a new technique to evaluate tumor angiogenesis in vivo, which can be repeated in vivo, relatively noninvasive, and can be used as a clinical diagnosis of PUC. Personalized treatment and prognostic judgment provide more information.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.1;R737.14

【参考文献】