Cervical Lymph Node Lesions In The CT Perfusion Imaging Performance And Angiogenesis State Of The Correlation Study

ObjectiveThrough researching the relationship among the CT perfusion parameter, micro-vessel density and vascular endothelial growth factor in the cervical lymphadenopathy,to evaluate the role of the angiogenesis in CT perfusion of the cervical lymphadenopathy.Through comparing the difference of perfusion parameter of the cervical lymph nodes diseases,to analyze the curve and parameter of CT perfusion in the benign lymphadenopathy (inflammatory lymph node, tuberculous lymph node)and malignant lymphadenopathy (lymphoma, thyroid cancer metastatic lymph nodes, other metastatic lymph nodes).to explore the application of CT perfusion imaging parameter in the qualitative diagnosis of cervical lymphadenopathy.Materials and methodsCollected69cases of benign and malignant cervical lymph node lesions proved by CT perfusion and pathology, than obtain the regions of interest of the time density curve (time density curve, TDC)by using DynEva software,and obtain the time to peak (time to peak, TTP)of lymph nodes and the relative reinforcing value (relative enhancement value, REV=the enhancement peak of lymph node-lymph nodes CT flat and value) according to the TDC; put the image obtained after the perfusion scan into Syngo Body PCT (Siemens, Germany) software can get the perfusion parameters:blood flow (blood flow, BF), blood volume (blood volume, BV), permeability (permeability,per). According to the histopathological results the69cases of lesions of lymph nodes are divided into benign group(inflammatory lymph node,tuberculous lymph nodes)and malignant group(lymphoma, Thyroid carcinoma metastasis lymph nodes, other cancer metastasis lymph node).the statistics of the perfusion parameter values in different lesions of lymph nodes,of which two samples are analyzing by t test, and the multiple-samples are using repeated measures to compare the perfusion parameters and TDC parameters in benign and malignant groups.Find the diseased tissue paraffin block and HE stained glass slides of the CT perfusion lymph node at the Department of pathology, to observe the pathological features of the tumor, to examine CD34and VEGF of lymph node lesions by immunohistochemical staining and to label the microvascular with CD34monoclonal antibody, according to Weidner's assessment standard [1] to calculate the coloring capillaries and tiny blood vessels within the lymph node lesions. Analyse the correlation between the CT perfusion imaging parameters of the lymph node lesions and the expression of MVD and VEGF by the statistical methods.Result1.In cervical lymph node lesions TDC curve form contrast, inflammatory lymph node TDC curve of benign lymphadenopathy to slow rise type (50.0%) and always turns defences inside type (37.5%) to give priority to. TCD curve of Tuberculous lymph node also to slow rise type (40.0%) and always turns defences inside type (40.0%) to give priority to. In Malignant lymphadenopathy. TCD curve of thyroid cancer metastasis lymph nodes To speed up main type dropped (70.6%). Other cancer (squamous cell carcinoma, gland cancer) transfer to speed up slow TDC lymph node down main type (65.0%); Lymphoma TDC always turns defences inside to main type (57.1%).2.BF, BV and Per value of Malignant lymphadenopathy benign lymph node are higher than Benign lymph node, as TTP value shorter than it, differences are statistically significant (p<0.05). But REV value in the benign and malignant lymph node no difference (p>0.05). Malignant group, thyroid cancer transfer lymph node perfusion has the obvious specific parameters, the BF value, BV value, and REV value Per value significantly higher than lymphoma and other cancer metastasis lymph nodes, difference was statistically significant (p<0.05). But TTP value difference was't statistically significant (p>0.05). CT perfusion parameters means little on identification between lymphoma and other cancer metastasis lymph node (p>0.05). Benign lymph node with inflammation and lymph node tuberculosis infection CT perfusion parameters are no significant difference (p>0.05).3.Differences between neck benign and malignant lymphadenopathy MVD has not statistically significant (p>0.05). The positive of strong in expression VEGF between the benign and malignant lymph nodes are statistically significant differences (p<0.05). Malignant thyroid cancer transfer between groups MVD lymph nodes, VEGF express positive mean differences are higher than other cancer metastasis lymph node and lymphoma, the difference was statistically significant (p<0.05). MVD mean differences, VEGF expression in lymphoma and other positive of cancer metastasis differences between the lymph node was not statistically significant (p>0.05). Between benign group, inflammatory lymphadenopathy and tuberculate of lymphadenopathy MVD mean differences, VEGF expression between positive were no statistically significant (p>0.05).4.The difference between Cervical lymph node lesions VEGF expression and the MVD number was not statistically significant (P>0.05).5.Results immunization groups MVD VEGF expression and content, and neck lymph nodes lesions of perfusion parameters:Good neck lymph node lesions, a vicious group of MVD VEGF expression and content, and REV, BV BF, is positively correlated.With a negative correlation between TTP, the differences are statistically significant (P<0.05);With no relevance between Per, no statistically significant difference (P>0.05).Inflammatory, tuberculosis, thyroid transfer lymph nodes, other cancer metastasis lymph nodes, lymphoma, cervical lymph node lesions in the MVD content, VEGF express strength and REV, BF, BV value are positively correlated relationship, and the TTP a negative correlation relationship, the differences are statistically significant (P<0.05); Per value and MVD, VEGF expression strength between was not statistically significant (P>0.05).Conclusion1.In the TDC curve shape in comparison, the TDC shape between inflammatory and tuberculous lymph node of benign lymph node has great overlaps,the main type is slow rise type and Lowland type. TDC of thyroid cancer metastasis lymph nodes always has rapid rise and falling fast, as in other cancer (squamous cell carcinoma, gland cancer) transfer lymph nodes rises rapidly and drops slow.TDC curve help in identifying benign and malignant lesions of cervical lymph node.2. BF,BV and Per value of perfusion parameters of Neck malignant lymph nodes higher than the benign group, TTP values of less than benign lymph nodes;REV values have no differences between benign and malignant lymph nodes. In the neck malignant lymph nodes, thyroid cancer metastasis lymph node in malignant lymph nodes have certain specific perfusion parameters, the value of its BF, BV value, Per value and REV were significantly higher than the value of lymphoma and other cancer metastatic lymph node.3.The positive of strong in expression VEGF in the neck benign and malignant lymph nodes has certain specific. MVD mean,VEGF expression of thyroid cancer metastasis lymph node higher than other cancers metastatic lymph nodes and lymphoma.4.MVD, VEGF and CT perfusion between parameters are closely related, CT perfusion scan imaging can reflect lesions angiogenesis state, CT perfusion parameters can be show from different aspects of the organization that cervical lymph node lesions micro circulation characteristics.