The Correlation Of CT Perfusion Imaging With Microvessel Density And Vascular Endothelial Growth Factor In Neoplasms Of Head And Neck

Part 1 Study of CT perfusion in neoplasms of head and neckObjective To study the perfusion CT (CTP) in neoplasms’of head and neck, and evaluate the value of CTP in the assessment of tumour angiogenesis as well as in the differential diagnosis of benign hypovascular lesions, benign hypervascular lesions and malignant lesions.Methods Forty-one neoplasms of head and neck proven by pathology were divided into three groups:Group A, benign hypovascular lesions; Group B, benign hypervascular lesions; and Group C, malignant lesions. All the patients had CTP examination before operation. The initial data of CTP was transferred to the Siemens workstation and was post-processed using the body perfusion software. The time density curves (TDCs) and CTP parameters including maximum intensity projection (MIP), blood volume (BV), blood flow (BF), mean transit time (MTT), and capillary permeability surface area product (PS) of the regions of interest (ROIs) were acquired. The shapes of TDCs and CTP parameters were analysed and compared among the three groups.Results The TDCs of neoplasms in head and neck could be classified into three types. TDC of type I had a slow ascending phase and had no apparent descending phase; TDC of type II had a steep ascending and a steep descending phase; TDC of type III had a steep ascending phase and a slow descending phase. TDC of type I was more frequently found in benign tumours (Groups A+B) than malignant tumours (Group C) (P=0.003). Malignant tumours mainly had TDCs of type II and type III. MIP, BV, and BF were all significantly higher in Groups B and C compared with Group A (all P< 0.01); PS value of Group B was significantly higher compared with Group A (P=0.002); Group B had higher MIP value than Group C (P=0.044).Conclusion The TDCs and parameters of CTP, especially the TDCs, MIP, BV and BF, may help the differential diagnosis of benign hypovascular lesions, benign hypervascular lesions and malignant lesions in head and neck.Part 2 The correlation of CT perfusion imaging with tumour angiogenesis in neoplasms of head and neckObjective To analyse the correlation between CTP parameters and microvessel density (MVD), vascular endothelial growth factor (VEGF) expression of neoplasms in head and neck, respectively.Methods After the examination of CT perfusion, all the 41 patients had operations as soon as possible. The tissue slices from the same level of CTP examination were acquired and were used for CD34 and VEGF antibody immunohistochemistry staining, followed by the calculation of MVD and VEGF expression level. The differences of MVD and VEGF expression were analysed among benign hypovascular lesions, benign hypervascular lesions and malignant lesions, and the relationship between the perfusion measurements and MVD/VEGF was assessed by Pearson correlation.Results There was no statistically significant difference in the MVD among the three groups (P>0.05). The VEGF expression of malignant tumours (Group C) was significantly higher than that of benign tumours (Groups A and B) (P=0.007). Pearson correlation showed that among the three groups, MVD was positively correlated with VEGF expression (r=0.314, P=0.046); MVD was positively correlated with MIP and BV, respectively (r=0.41,0.352; P=0.008,0.024); no correlation was found between VEGF expression and any of the CT perfusion parameters (P> 0.05).Conclusion The shapes of TDCs, MIP and BV of CTP may reflect angiogenesis of neoplasms in head and neck indirectly. CTP may help the differential diagnosis of the three groups of neoplasms in head and neck.