The Value Of One-stop Scan Spectral Imaging And Perfusion In The Differentiate Diagnosis Of Rabbit Axillary Lymph Nodes

Part I: The Establishment of rabbit models of axillary metastatic lymph nodes with implanted VX2 breast cancer and inflammatory reactive hyperplastic lymph nodes ObjectiveTo establish rabbit models of axillary metastatic lymph nodes with VX2 implanted breast cancer and inflammatory reactive hyperplastic lymph nodes.And to evaluate whether the model set up successful by general observation and pathological diagnosis.Material and methods1.Sixty purebred female New Zealand white rabbits were randomly divided into two equal groups,tumor metastasis group and inflammatory reactive hyperplastic group.Age eight months2.1ml VX2 tissue mass suspension was injected into the unilateral rabbit's second mammaris so as to set up the tumor-bearing model.And tumor growth and axillary swollen lymph node were observed weekly.At the weekend of first,the tumor tissue of a rabbit was randomly selected for pathological examination.Take 2-3 weeks randomly two experimental rabbit tumor tissue and ipsilateral axillary lymph node were taked pathological examination.Observation tumor and ipsilateral axillary lymph node enlargement in the 4th weekend.The experimental rabbit model of axillary metastatic lymph nodes set up successfully at this point.The inflammatory group was injected with 1ml egg yolk emulsion on the side of the side of the chest wall of the second breast wall and the side of the ipsilateral upper limb.And then the axillary lymph nodes were observed.Results:1.Rabbit model of axillary metastatic lymph node with VX2 breast cancer: 30 experimental rabbits were formed 5-10 mm nodules after VX2 implanted only 1 weeks and untouched axillary lymph nodes,the mean size is about(7.1±1.96)mm,the tumor noldule was confirmed by pathology.After 2 weeks,the tumor size of 29 rabbits was about 20 mm,the mean size is about(21±3.97)mm,the tumor formation rate was 100%.17.2%(5/29)experimental rabbit axillary lymph node diameter 5mm below,breast tumor was confirmed by pathology,tumor cells were not found in lymph nodes.After 2 to 3 weeks(average 19 days),the growth was rapid,Some tumors grow into 3.5cm * 3.5cm * 3.5cm,the mean size is about(32 + 2.37)mm,axillary lymph node enlargement to 20 mm size.Pathological results showed that the tumor tissue and lymph nodes were infiltrated.The tumor size was approximately(36 + 2.72)mm in fourth weeks,25 implanted rabbit breast cancer models were established and all with axillary enlarged lymph nodes.The surface of 1 experimental rabbit axillary enlarged lymph nodes is not smooth,60%(15/25)experimental rabbit tumor necrosis occurred,24%(6/25)experimental rabbit tumor surface skin ulceration,and see white bean curd residue like necrosis.One experimental rabbit died.Finally,a total of 24 experimental rabbits were successfully modeled(the successful planting rate was 96%).2.Rabbit axillary inflammatory reactive hyperplastic lymph node animal model : 30 experimental rabbits were injected with egg yolk emulsion for five days later,axillary lymph nodes of 2 experimental rabbits were touched.After reinforcement,axillary lymph nodes of 25 rabbits were touched in the second weeks.those of 30 rabbits were touched in the third weeks.2 rabbits died due to thoracic and abdominal infection.Finally,model of 28 rabbits were successfully established(Planting success rate was 93.3%)ConclusionIt is easy to establish he model of rabbit VX2 breast cancer axillary lymph node metastasis and inflammatory reaction of hyperplastic lymph nodes.High molding rate and the experimental rabbits were well tolerated.Part II: An experimental study on the differential diagnosis of breast cancer axillary metastatic lymph nodes and inflammatory reactive hyperplastic lymph nodes by one stop CT energy spectrum perfusion imaging ObjectiveTo explore the metastasis of breast cancer and inflammatory reactive hyperplastic lymph nodes of different characteristic perfusion parameters and energy spectrum parameters,the diagnostic value of different parameters,the optimal parameters for different diagnosis methods and optimum parameters.And to provide an important objective basis for the clinical application of the latter.Material and methods1.All the successful models of 24 rabbits tumor metastasis group and 28 rabbits inflammatory group were performed one-stop spectrum perfusion imaging scanning.And all the original images were transferred to GE AW4.6 postprocessing workstation for postprocessing.The axillary lymph nodes with short diameter larger than 5mm were post treated.2.Perfusion analysis using Perfusion 4-body tumor software,Select aorta as input artery,Get ROI lymph node lesions perfusion status within the scope of pseudo color map and blood volume,blood flow,mean transit time,permeability surface of four parameters.3.Select delay 34S(No.12 pass),58s(No.24pass)as arterial phase and venous phase,70 ke V Image reconstruction selection,1.25 mm Thick layer,40%ASi R.Using GSI Viewer analysis software,Measurement of IC in the range of ROI in the arterial phase and venous phase on iodine kitu;At the same time choose with aortic IC for standard reference value,From one period to the lymph nodes of IC with aortic IC ratio as lymph node standardized iodine value of the base,respectively arterial standardized iodine value and Venous phase standardized iodine based value.In the arterial and venous phase measuring ROI on water-based diagram within the scope of the WC(WCAP)arterial and venous phase WC(WCv P).Analysis of lymph node arterial and venous phase between 40 kev and 70 kev energy spectrum curve of the slope: ?HU=(40ke VHU-70 ke VHU)/30 ke V.The standardization of lesions effective atomic number(Zeff-c=Zefflymph/Zeffaortic).4.Receiver Operating Characteristic(ROC)analysis of CT perfusion parameters and spectral parameters value in the differential diagnosis of axillary lymph node metastasis and inflammatory reactive hyperplasia,with the area under curves as the evaluating standard of value judgment,based on the maximum Youden index,the optimal threshold selection and calculation of the diagnostic sensitivity accordingly,the specificity and the positive predictive value and negative predictive value.Results1.The BF of lymph nodes in metastasis group was significantly higher than that in the inflammatory group,The difference is statistically significant(P=0.001);The BV value and PS value of lymph nodes in the metastasis group were slightly higher than that in the inflammatory group,and the difference between the BV values was statistically significant(P=0.01);The difference of PS value was not statistically significant(P=0.524);The mean value of MTT in lymph node metastasis group was lower than that in the inflammatory group,the difference was not statistically significant(P=0.157).2.Area under the curve of BF and BV are 0.827,0.712.The BF is greater than 47.95 ml.min-1.100g-1 as the threshold,the maximum Youden index was 0.605,the sensitivity,specificity,positive predictive value and negative predictive value were 90.91%,69.39%,66.7%,91.9%.With more than 3.97 ml.BV 100g-1 as the threshold value,the maximum youden index income was 0.439,the sensitivity,specificity,positive predictive value and negative predictive value were 93.94%,48.98%,55.4%,92.3%.The value of parameter BF value in the differential diagnosis of metastatic and inflammatory lymph nodes has a high diagnostic value.When the BF value was greater than 47.95 ml.min-1.100g-1,the correct rate of diagnosis of lymph node metastasis was 66.7%,and the correct rate of diagnosis for inflammatory reactive lymph nodes was 91.9%.3.IC,NIC,?HU,Zeff-c,and WC in the arterial phase of the metastatic lymph nodes of the metastatic lymph nodes are all higher than those in the inflammatory group.The difference of ICAP,NICAP,AP?HU was statistically significant(P=0.032;P < 0.001;P< 0.001),and there was no significant difference in Zeff-c and WC between the two groups(P=0.078;P=0.595).4.IC,NIC,HU,Zeff-c,and WC in the venous phase of the metastatic lymph nodes of the metastatic lymph nodes are all higher than those in the inflammatory group.The difference of ICVP,NICVP,VP?HU was statistically significant(P=0.001;P=0.017;P<0.001),and there was no significant difference in Zeff-c and WC between the two groups(P=0.118;P=0.616).5.The area under the curve of ICAP,NICAP,AP?HU,ICVP,NICVP,VP AP?HU is 0.640,0.757,0.852,0.736,0.761,0.818,respectively.AP?HU more than 3.28 as a threshold,the maximum Youden index was 0.717,the sensitivity,specificity,positive predictive value and negative predictive value were respectively 75.77%,95.92%,92.6%,85.5%.With AP?HU and NICVP as the joint diagnostic parameters,the area under the curve was 0.901,the most about the index of 0.718.When the AP?HU was greater than 3.18 and NICVP was greater than 0.27 as the best threshold value,the sensitivity,specificity,positive predictive value and negative predictive value were 81.82%,93.88%,89.3%,88%,respectively.The correct rate of diagnosis of lymph node metastasis was 89.3%,and the correct rate of diagnosis for inflammatory reactive lymph nodes was 88%.6.By using BF and AP?HU,BF and VP?HU as the joint parameters,the area under the curve was 0.899 and 0.913,BF combined VP?HU with a single BF?VP?HU is a statistical difference(P=0.045,0.023).And BF combined AP?HU with a single BF?AP?HU is no significant statistical difference(P=0.055,0.173).The AUC of three joint parameters(AP?HU +NICVP +BF)?(AP?HU+BF+VP?HU)were 0.918,0.942,and there was no significant difference between the two parameters,and the diagnostic sensitivity was only 78.79%.Selection the BF value is greater than 45.29 ml.min-1.100g-1 and VP?HU values greater than 3.81 as the optimal threshold,the maximum Youden index was 0.766,the sensitivity,specificity and positive predictive value and negative predictive value were 90.92%,85.81%,81.1%,93.3%.Therefore,the selection of BF and VP?HU as the joint parameters of the diagnosis of lymph nodes can achieve a better diagnostic value.Conclusion1.The BF value and BV value of metastatic lymph nodes were higher than that of inflammatory lymph nodes and there were significant differences.Parameter BF value has a good diagnostic value and can be used for differential diagnosis of metastatic lymph nodes and inflammatory reactive hyperplasia lymph nodes.2.ICAP?NICAP??HUAP?ICVP?NICVP??HUVP of metastatic lymph node in energy spectrum parameters were higher than inflammatory hyperplastic lymph nodes,and the differences are statistically significant.Selection of AP?HU is greater than 3.18 and NICVP is greater than 0.27 as the best diagnostic threshold,the maximum Youden index was 0.718,the sensitivity,specificity and positive predictive value and negative predictive value were 81.82%,93.88%,89.3%,88%.Combined AP?HU and NICVP can improve the diagnostic value of the differential diagnosis of metastatic lymph nodes and inflammatory hyperplastic lymph nodes3.One-stop energy spectrum and perfusion imaging can realize perfusion imaging under the condition of energy spectrum imaging.,it can provide more parameters;Spectral imaging and CT perfusion imaging in the differential diagnosis of benign and malignant lymph nodes have a certain value,Combined use of two kinds of imaging parameters can be used to improve the diagnostic value of differential diagnosis of axillary metastatic lymph nodes and inflammatory hyperplastic lymph nodes.Select the BF value is greater than 45.29 ml.min-1.100g-1 and VP?HU greater than 3.81 as the optimal threshold,the maximum Youden index was 0.766,the sensitivity,specificity and positive predictive value and negative predictive value were 90.92%,85.81%,81.1%,93.3%.Part?: Study on the relationship between the axillary lymph nodes and the lymphatic vessels?blood vessels in rabbits ObjectiveTo explore the correlation between the expression of VEGF,VEGF-C,MVD,MLVD and the spectral perfusion parameters in metastatic lymph nodes and inflammatory reactive lymph nodes.Material and methodsAfter the one-stop energy spectrum CT perfusion imaging scanning,the axillary lymph nodes with a short diameter of more than 5mm.were obtained from the experimental rabbits.According to the scanning plane cutting layer,lymph nodes were stained by HE and observed with optical microscopes.Quantitative analysis of VEGF and VEGF-C in lymph nodes by En Vision method,and counting and microvascular density(MVD)and lymphatic vessel density(MLVD).The expression level of VEGF,VEGF-C,MVD and MLVD in lymph nodes in the metastasis group and the inflammatory group were analyzed.And the correlation between perfusion parameters,energy spectrum parameters and immune histochemical parameters were analyzed.Results1.In the metastasis group,39 lymph nodes were obtained,of which 36 were metastatic lymph nodes,and 3 were inflammatory reactive lymph nodes;and a total of inflammatory reactiveclymph nodes was 46.2.The MVD,VEGF-C,MLVD and VEGF of metastatic lymph nodes were all higher than those of inflammatory lymph nodes and the difference was statistically significant(P=0.011,0.000,0.015,0.002).3.The BF was positively correlated with VEGF,VEGF-C and MLVD,and the correlation was statistically significant(r=0.349,P=0.01;r =0.323,P=0.016;r= 0.385,P=0.008),and no obvious correlation with MVD(r=0.176,P=0.176).There was no correlation between the BV and VEGF,VEGF-C,MVD and MLVD(r=0.098,P= 0.380;r =0.177,P = 0.113;r = 0.09,P = 0.420;r = 0.184,P = 0.098).4.ICAP value and MLVD value of lymph nodes were positively correlated(r=0.282,P=0.01).NICAP was positively correlated with VEGF expression(r=0.240,P=0.03).ICVP and NICVP in lymph nodes were positively correlated with VEGF,VEGF-C,MVDand MLVD(P<0.05).There was obvious correlation between AP?HU,VP?HU and VEGF,MVD,VEGF-C,MLVD(P<0.05).In contrast,the correlation of VP?HU and VEGF-C,MLVD,MVD,MLVD,VEGFwas the most significant(r=0.406,0.421,0.398,0.448),which was the strongest correlation with MLVD.Conclusion1.The expression of VEGF,VEGF-C,MVD and MLVD in metastatic lymph nodes and inflammatory reactive hyperplastic lymph nodes was different.It Can be used to differentiate benign and malignant lymph nodes.2.There was obvious correlation between BF?IC?NIC??HU and VEGF,MVD,VEGF-C,MLVD.And the realationship was strongest between VP?HU and MLVD.3.The parameters of CT perfusion and energy spectrum can reflect the formation of blood vessels and lymphatic vessels in lymph nodes.It is expected to provide a basis for further study of primary tumor and lymph node metastasis.