Study Of CT Perfusion Imaging For Breast Tumors And Its Correlation With Microvessel Density

Part I: Study of CT perfusion for breast tumorsObjective: To study and assess the CT perfusion characteristics of breast tumors; To investigate the clinical value of CT perfusion imaging.Methods: Sixty patients with cancer (n=30) ,whose age was ranging from 37 to 76 years (median 50 years), lesion size from 0.60 to 10.00cm (median 3.41cm) fibroadenoma (n=14) whose age was ranging from 20 to 55 years (median 47 years), lesion size from 1.20 to 10.90 cm (median 4.60 cm), other benign diseases (n=16) whose age was ranging from 36 to 71 years (median 49 years), including cyst, hyperplasia, scar tissues afer operation and fulham embedded, and reexamined(n=6) whose age was ranging from 42 to 67 years (median 51 years), lesion size from 1.50 to 4.90 cm (median 2.30 cm), were underwent breast CT scan. Contrast injection was done by using 60 ml nonionic contrast agent, at a flow rate of 6ml/s with a power injector, 5 seconds delay, scanning one time per 2s in the first minute and per 4s in the last two minutes, and data acquisition totally lasted for 3 minutes, 5minutes if necessary. These data were processed on a perfusion software Basama 6.0 package, and the TDC of region of interested was drawn, the mean BF, BV, TTP were measured and statistically analyzed.Results: The TDC of breast cancer and fibroadenoma was obviously varied, and was classified three types. Most of TDC of breast cancer were type one or type two, and the accuracy of type one and two for breast cancer is 86.4%, while most of TDC of fibroadenoma were type three. The mean BF, BV, TTP between carcinoma and normal breast were statistically significant (P<0.05).The mean BF and TTP between carcinoma and fibroadenoma were statistically significant (P<0.05) ,while the mean BV between them was not statistically significant (P>0.05) . The mean BF ,BV and TTP between carcinoma and other benign lesions were statistically significant (P < 0.05). The mean BF and TTP of reexamined group before and after therapy were not statistically significant (P<0.05) , while the mean BV between them was not statistically significant (P>0.05).Conclusions: The TDC of breast cancer and fibroadenoma wss different, and it could be used to differentiate breast and fibroadenoma, but some atypical cases also needed to combine morphological features and CT perfusion parameters and so on. The perfusion manifestation of breast cancer was different from normal breast, fibroadenoma and other benign lesions. The perfusion of breast cancer show high perfusion, and its characters were helpful to differentiate breast cancer and fibroadenoma. The mean BF and TTP between carcinoma and fibroadenoma were statistically significant, and the perfusion parameters of carcinoma and other benign lesions were statistically significant. The mean BF and TTP of reexamined group before and after chemotherapy were not statistically significant, but the mean BF descended after chemotherapy, and TTP was delayed.Part II: Correlation of CT perfusion and microvessel density in breast tumorsObjective: To study the morphological characteristics of microvessel in breast tumors, including breast cancer and fibroadenoma, and to study the correlation between MVD and CT perfusion parameters separately; To distinguish the differences of MVD between breast cancer and fibroadenoma.Methods: 23 cases from the former part,all female,were undergone preoperative CT perfusion without chemotherapy in the 307 hospital of PLA, consisting of 15 breast cancer with ages ranging from 38 to 75 years old (median 55 years), lesion size from 0.60 to 8.50 cm(median 3.00 cm), including 12 soaked carcinoma,1 medullary carcinoma and 2 carcinoma simplex, and 8 fibroadenoma with ages ranging from 20 to 55 years old (median 45 years), lesion size from 1.20 to 10.90 cm (median 4.50 cm), including 1 giant fibroadenoma, 1 multiple fibroadenoma, 1 fibroadenoma with hematoma. Microvessel density (MVD) of breast cancer and fibroadenoma were measured with IHC and counted according to Weidner methed. The correlations between MVD and parameters of CT perfusion in breast cancer and fibroadenoma were statistically analyzed. MVD of breast cancer and fibroadenoma were also statistically analyzed.Results: BF, as one of the parameters of CT perfusion, its mean of breast cancer cases(n=15) is 26.23±11.28 ml/min/100g, the mean BV is 23.98±7.42 ml/100g, the mean TTP is 55.33±16.89s, and the mean MVD is 45.66±9.05 with 200 times screenfield. BF of breast carcinoma tended to be positively correlated with MVD(r₁=0.42,P₁<0.05),TTP was negatively correlated with MVD(r₃=-0.74,P₃<0.05), while BV was not significantly correlation with MVD(r₂=0.18,P₂>0.05); The parameter of CT perfusion of breast fibroadenoma cases(n=8), the mean BF is 10.08±2.34 ml/min/100g, the mean BV is 20.45±5.13 ml/100g, the mean TTP is 125.00±10.95s, and the mean MVD is 37.18±10.91 with 200 times screenfield. BF and BV of fibroadenoma similarly tended to be positively correlated with MVD(r₁=0.53,P₁<0.05; r₂=0.66,P₂<0.05), while TTP was not significantly correlation with MVD(r₃=0.32,P₃>0.05). Moreover, the mean of MVD of breast cancer was higher than fibroadenoma, but between them was not statistically significant(P>0.05).Conclusions: The parameters of CT perfusion imaging had close correlation with MVD, so CT perfusion imaging could dynamically reflex microvessel of breast neoplasm. It coule be applied to evalue the angiogenesis of tumors in tissue living, and supply more theoretical evidence for studying the relation between CT perfusion imaging and prognosis. Moreover, the mean of MVD of breast cancer was higher than fibroadenoma, but between them was not statistically significant.