Correlation Between Tumor Angiogenesis And Imaging Features Of Multiphasic Spiral Computed Tomography And Contrast-enhanccd Ultrasound In Renal Cell Carcinoma

Objective: To investigate the correlation of imaging features of Multiphasic Spiral Computed Tomography(SCT) and contrast-enhanccd ultrasound(CEUS) with the expression of tumor microvessel density (MVD)and vascular endothelial growth factor(VEGF),also with pathological features in renal cell carcinoma(RCC).Materials and Methods: Thirty patients with RCC diagnosed by pathology underwent SCT and US examinations. MVD and VEGF were examined immunohistochemically using SP techniques.MVD were detected with mouse anti-human CD34 monoclonal antibody staining and expression of VEGF were detected with the rabbit anti-VEGF noclonal antibody staining.The relationship of imaging features SCT and CEUS with pathology, MVD and expression of VEGF was compared thoroughly.Results:(1)The results of SCT:The detection and characterization rate as well as accuracy of staging before operation about 30 RCC of multiphasic SCT scans were 100%,100% and 83.3%,respectively.CRCC showed stronger enhancement than the other subtypes (P<0.05)in the CMP.CRCC tended to show heterogeneous or predominanty peripheral enhancement in the CMP.PRCC are typically hypovascular and homogeneous.On multiphasic SCT scans,the pathological nuclear grade,the MVD and positive expression of VEGF in groups of RCC with diameter larger than 3.0cm ,central necrosis, pseudocapsule and intravenous tumor emboli were obviously higher those of the contrast group (P<0.05,P<0.05,P<0.05,respectively). The pathological nuclear grade and MVD in groups of RCC with lymph node metastasis were higher than the contrast group(P<0.05,P<0.05,respectively).There were the positive correlation between the enhanced Hounsfield's units in the CMP and the MVD in 30 cases of RCC(r=0.784,P<0.05). The degree of enhancement correlated well positively with the MVD in 30cases of RCC(P<0.05).(2) The results of US: The detection and characterization rate as well as accuracy of staging of 30 RCC of CEUS were 100%,93.33% and 70%,respectively. CRCC showed stronger enhancement than the other subtypes (P<0.05)in the CMP.CRCC tended to show heterogeneous or predominanty peripheral enhancement in the CMP.PRCC are typically hypovascular and homogeneous. On US scans,the pathological nuclear grade and the MVD in groups of RCC with rich blood flow(Ⅱ+Ⅲ),significantly higher strengthen echo were higher than those of the contrast group(P<0.05). There were the positive correlation between tumor blood flow richness and the MVD in 30 cases of RCC(r=0.429,P<0.05),so dose the PI and the MVD(r=0.57,P<0.05).(3)The results of pathology: In 30 cases of RCC ,the mean MVD was 36±12.4.The positive expression rate of VEGF were 73.33%(22/30).At pathologic evaluation,MVD and positive expression of VEGF were obviously higher in groups of tumor having high nuclear grade and high stage than in those of tumor having low nulear grade and low stage(P<0.05). MVD in group of positive expression of VEGF were obviously higher than group of negative expression of VEGF(P<0.05).There were not the correlation between the MVD and the expression of VEGF in 30 cases of RCC(rs=0.057,P>0.05).Conclusions: (1)Multiphasic SCT enhanced scans was a reliable technique in the diagnosis of RCC,as a macro indicators reflecting the biological behavior of RCC.(2)The diagnostic accuracy of qualitative and staging of RCC by US were improved with CEUS.The MVD and expression of VEGF could be objectively deduced according to the CEUS features of RCC , but there are some limitations.There may be a noninvasive method to predict production ,aggressiveness and prognosis of RCC at molecular biological level ,and may be to provide valuable imaging basis to select antiangiogenesis therapy through the advantages of multiphase SCT enhanced scanning and CEUS.