直肠癌DCE-MRI定量分析参数与微血管生成的相关性分析

doi:10.19401/j.cnki.1007-3639.2025.03.008

摘要/Abstract

摘要：

背景与目的：肿瘤微血管生成是肿瘤生长、转移的重要基础，其特征包括血管新生、血管通透性增加及毛细血管结构异常等。微血管生成不仅影响肿瘤的供血和代谢，还与肿瘤的侵袭性、患者预后及治疗反应直接相关。动态对比增强磁共振成像（dynamic contrast-enhanced magnetic resonance imaging，DCE-MRI）是一种非侵入性的影像学技术，通过定量分析对比剂在肿瘤组织中的分布和动态变化，能够反映肿瘤的微血管密度（microvascular density，MVD）、通透性和血流灌注状态。本研究旨在通过深入分析直肠癌DCE-MRI定量分析参数与微血管生成的关系，进一步明确其在直肠癌诊断和治疗中的应用价值，并推动该技术在临床实践中的普及和优化。方法：选取2021年1月—2024年6月新乡市中心医院收治的348例拟行手术治疗的直肠癌患者，并收集直肠癌组织标本和癌旁组织（距离肿瘤边缘>5 cm）。本研究经新乡市中心医院医学伦理委员会审批通过（批号：2021-144-01K）。比较癌组织、癌旁组织中的DCE-MRI定量分析参数[速率常数（rate constant，K_ep）、容积转运常数（volume transfer constant，K^trans）、细胞外间隙对比剂容积分数（extravascular extracellular volume fraction，V_e）]和MVD。对比不同分化程度、临床分期直肠癌患者的DCE-MRI定量分析参数和MVD。采用Spearman相关系数分析直肠癌患者的DCE-MRI参数与分化程度、临床分期及MVD的相关性。结果：直肠癌组织的K_ep值、K^trans值、V_e值及MVD均高于癌旁组织（P<0.05）。低分化和中分化直肠癌患者的K_ep值、K^trans值、V_e值及MVD均高于高分化直肠癌患者（P<0.05），低分化直肠癌患者的K_ep值、K^trans值、V_e值及MVD均高于中分化直肠癌患者（P <0.05）。Ⅱ期、Ⅲ期和Ⅳ期直肠癌患者的K_ep值、K^trans值、V_e值及MVD均高于Ⅰ期直肠癌患者（P<0.05），Ⅲ期和Ⅳ期直肠癌患者的K_ep值、K^trans值、V_e值及MVD均高于Ⅱ期直肠癌患者（P<0.05），Ⅳ期直肠癌患者的K_ep值、K^trans值、V_e值及MVD均高于Ⅲ期直肠癌患者（P<0.05）。直肠癌患者的K_ep值、K^trans值及V_e值与分化程度均呈负相关（r=-0.683、-0.743、-0.721，P<0.05），直肠癌患者的K_ep值、K^trans值及V_e值与临床分期均呈正相关（r=0.764、0.703、0.814，P<0.05），直肠癌患者的K_ep值、K^trans值及V_e值与MVD均呈正相关（r=0.812、0.754、0.835，P<0.05）。结论：DCE-MRI参数与直肠癌分化程度、临床分期及微血管生成均相关。

关键词: 直肠癌, 动态对比增强磁共振成像, 定量参数, 分化程度, 临床分期, 微血管生成

Abstract:

Background and purpose: Tumor microangiogenesis is an important basis for tumor growth and metastasis, and its characteristics include angiogenesis, increased vascular permeability and abnormal capillary structure. Microangiogenesis not only affects the blood supply and metabolism of tumor, but also is directly related to the invasion, prognosis and treatment response of tumor. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is a non-invasive imaging technique. By quantitatively analyzing the distribution and dynamic changes of contrast agents in tumor tissues, it can reflect the microvascular density (MVD), permeability and blood perfusion of tumors. The purpose of this study was to further clarify the application value of DCE-MRI in the diagnosis and treatment of rectal cancer by in-depth analysis of the relationship between quantitative analysis parameters of rectal cancer and microangiogenesis, and to promote the popularization and optimization of this technology in clinical practice. Methods: A total of 348 patients with rectal cancer who were scheduled for surgical treatment in Xinxiang Central Hospital from January 2021 to June 2024 were selected, and rectal cancer tissue specimens and adjacent tissues (> 5 cm away from tumor margin) were collected. This study was approved by the medical ethics committee of Xinxiang Central Hospital (approval number: 2021-144-01K). The quantitative analysis parameters of DCE-MRI [Rate constant (K_ep), volume transport constant (K^trans), volume fraction of contrast agent in extracellular space (VE)] and MVD in cancer tissues and adjacent tissues were compared. The quantitative analysis parameters and MVD of DCE-MRI in rectal cancer patients with different differentiation degrees and clinical stages were compared. Spearman correlation was used to analyze the correlation between DCE-MRI parameters and differentiation degree, clinical stage and MVD in patients with rectal cancer. Results: The values of K_ep value, K^trans value, V_e value and MVD were higher in rectal cancer tissues than in adjacent tissues (P<0.05). The K_ep value, K^trans value, V_e value and MVD of patients with low differentiated and middle differentiated rectal cancer were higher than those of patients with high differentiated rectal cancer (P<0.05). The values of K_ep value, K^trans value, V_e value and MVD of patients with low differentiated rectal cancer were higher than those of patients with middle differentiated rectal cancer (P<0.05). The K_ep value, K^trans value, V_e value and MVD of patients with stage Ⅱ, Ⅲ and Ⅳ rectal cancer were higher than those of patients with stage Ⅰ rectal cancer (P<0.05). The K_ep value, K^trans value, V_e value and MVD of patients with stage Ⅲ and Ⅳ rectal cancer were higher than those of patients with stage Ⅱ rectal cancer (P <0.05). The K_ep value, K^trans value, V_e value and MVD of patients with stage Ⅳ rectal cancer were higher than those of patients with stage Ⅲ rectal cancer (P<0.05). The K_ep value, K^trans value and V_e value of rectal cancer patients were negatively correlated with the differentiation degree (r=-0.683, -0.743, -0.721, P<0.05). The K_ep value, K^trans value and V_e value of rectal cancer patients were positively correlated with clinical stage (r=0.764, 0.703, 0.814, P<0.05). The K_ep value, K^trans value and V_e value of rectal cancer patients were positively correlated with MVD (r=0.812, 0.754, 0.835, P<0.05). Conclusion: DCE-MRI parameters are related to the differentiation degree, clinical stage and microangiogenesis of rectal cancer.

Key words: Rectal cancer, Dynamic contrast-enhanced magnetic resonance imaging, Quantitative parameters, Degree of differentiation, Clinical staging, Microangiogenesis

中图分类号:

R735.3+7

宋丹, 柴亚欣, 葛延平. 直肠癌DCE-MRI定量分析参数与微血管生成的相关性分析[J]. 中国癌症杂志, 2025, 35(3): 320-325.

SONG Dan, CHAI Yaxin, GE Yanping. Relationship between quantitative analysis parameters of DCE-MRI and microangiogenesis in rectal cancer[J]. China Oncology, 2025, 35(3): 320-325.

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Tissue	K_ep value/min	K^trans value/min	V_e value	MVD
Rectal cancer tissue (n=348)	2.61±0.59	0.84±0.17	0.63±0.14	30.69±5.27
Adjacent peritumoral tissues (n=348)	1.57±0.36	0.43±0.12	0.31±0.11	18.72±4.81
t value	28.070	36.756	33.528	31.296
P value	<0.001	<0.001	<0.001	<0.001

Degree of differentiation	K_ep value/min	K^trans value/min	V_e value	MVD
Highly differentiation (n=68)	2.04±0.41	0.52±0.13	0.38±0.12	23.46±5.73
Moderate differentiation (n=174)	2.53±0.53^a	0.83±0.19^a	0.59±0.19^a	30.18±6.09^a
Poorly differentiation (n=106)	3.11±0.65^ab	1.06±0.24^ab	0.87±0.26^ab	39.25±6.81^ab
t value	82.271	155.608	128.129	141.469
P value	<0.001	<0.001	<0.001	<0.001

Clinical stage	K_ep value/min	K^trans value/min	V_e value	MVD
Ⅰ (n=79)	1.91±0.43	0.51±0.17	0.37±0.11	22.87±4.65
Ⅱ (n=116)	2.42±0.51^a	0.83±0.21^a	0.56±0.15^a	28.65±5.79^a
Ⅲ (n=88)	2.87±0.62^ab	0.94±0.26^ab	0.75±0.24^ab	32.40±6.51^ab
Ⅳ (n=65)	3.45±0.74^abc	1.12±0.31^abc	0.91±0.28^abc	41.52±7.38^abc
t value	96.258	86.430	103.774	118.998
P value	<0.001	<0.001	<0.001	<0.001