Contrast Study On Renal Carcinoma Vascularity With Doppler Ultrasonography And Pathologic Immunohistochemistry

Objection:To study renal carcinoma vascularity with color Doppler flow imaging (CDFI),pulsed wave Doppler (PW) and three-dimensional color power angrography (3D-CPA),the blood supply and hemodynamic parameters were recorded ,tumor vascularity index (VI)of 3D-CPA was then quantified in the study .All the slices of tumor tissue specimens excised operatively were performed immunohistochemistry with anti-CD105 and anti-α-smooth muscle actin (α-SMA) monoclonal antibody. The microvessel density (MVD) and arteriolar fraction (AF) were calculated separately. The results of Doppler ultrasonography were compared with those of immunohistochemistry, so as to explore the pathologic basis of Doppler ultrasonography in detecting tumor vessels quantitatively and to evaluate its clinical value in diagnosing preoperatively, choosing the operation and assessing treatment effects and prognosis of renal carcinoma .Materials and methods :36 renal carcinomas (24 clear cell carcinomas,11 adenomatosa carcinomas and one undifferentiated carcinoma )were examined with Dopplerultrasonography ,all cases fasting 12 hours before examinations and in supire or lateral position. 2D gray-scale sonography was used to depict the position ,size, outline,inner echo and the adjacencies rounding renal carcinoma. The maximum and minimal diameters were measured. The average diameters were counted as the diameters(D)of tumor ,and its volumes (V)were calculated as follows:V=4/3π(D/2)3.Infer vena cava(IVC), renal vein and the area next to great and reniportal blood vessels were observed to detect cancer embolie and lymphatic metastasis respectively. According to Robson and Doppler ultrasonography ,the clinical stage (Ⅰ~Ⅳ)of renal carcinoma was done .The blood supply was showed with CDFI,CPA, and the blood flow distribution was observed. The optional PW spectra were acquired with sample volume 2 mm, angle between the sample line and blood flow less than 300.The peak systolic velocity (PSV)and resistance index (RI)of intratumor and peritumor vessels were measured and their average were recorded .Under the satisfied CPA condition ,patients were told to hold breath. 3D key was started. The tumor vascularity was reconstructed with 3D-CPA and the images were stored in MO to further study the whole distribution of tumor vessels. The numbers of blood vessels were counted and the vascularity index (VI)(count/cm3) was calculated. Immunohistochemistry of renal carcinomas were done with anti-CD105 and anti-α-SMA monoclonal antibody after operation. The MVD of anti-CD105( MVDCD105 ) and MVD of anti-α-SMA( MVDα-SMA )were calculated separately and AF was counted. AF=MVDα-SMA /MVDCD105,which reflecting the arterial ratio of tumor vessels. The results above were analyzed statistically.Results: 1.36 renal carcinomas were examined with gray-scale ultrasonography ,which 15 cases were in left kidney and 21 cases were in right kidney. The sizes were 3.53×2.7~13.42×8.65(Dmax×Dmin). The cases of clinical stage Ⅰ~Ⅲ were 10,17 and 9 respectively. Intratumor and peritumor blood supply were detected, whose PSV were (57.90±43.79)cm/s and (69.54±38.53)cm/s and whose RI were (0.51±0.14) and (0.60±0.12). The average of PSV and RI were (69.58±38.05)cm/s and (0.56±0.11). The RI of intratumor artery was lower than that of peritumor one, whose difference was significant (P<0.05).There was no significant difference between in-PSV and per-PSV.(P>0.05) Most blood supply of renal carcinomas were rich. The blood supply of renal caicinoma displayed as high velocity and low resistance. VI value of 3D-CPA was (0.322±0.193) count/ cm3.Differences of VI values with different pathologic types,histological grades and tumor Dmax were significant(P<0.05).2.All the slices of tumor specimens were stainedimmunohistochemically with anti-CD105 and anti-α-SMA monoclonal antibody. The membrane of vessel endothelia cell (VEC) and the plasma of smooth muscle cell (SMC) expressed brown. The morphologies and dis...