影像科学与光化学

目的：探究64层螺旋CT灌注成像在评估进展期胃癌血管生成及新辅助化疗疗效中的应用价值。方法：选取2020年9月至2023年3月期间医院收治的107例进展期胃癌患者作为研究对象，于新辅助化疗前及化疗2个周期后进行64层螺旋CT检查，获取胃癌组织及癌旁正常组织的CT灌注成像参数，并通过免疫组化法评估微血管密度（MVD）和血管内皮生长因子（VEGF）蛋白表达水平。采用Pearson相关分析法分析CT灌注成像参数与MVD、VEGF的相关性，并通过受试者操作特征（ROC）曲线分析CT灌注成像参数对新辅助化疗疗效评估的价值。结果：胃癌组织的血流量（BF）、血容量（BV）和血管表面通透性（PS）均高于癌旁组织（P<0.001），且与MVD、VEGF呈正相关（P<0.001）。化疗后，病理完全缓解（pCR）组患者的BF、BV和PS减少率均高于病理未完全缓解（NpCR）组（P<0.001），有效组化疗后的减少率也高于无效组（P<0.001）。ROC分析显示，BF、BV和PS减少率预测新辅助化疗疗效的曲线下面积（AUC）分别为0.813、0.762、0.842。结论：64层螺旋CT灌注成像参数能够反映进展期胃癌的血管生成情况，并准确评估新辅助化疗后的病理学反应及临床疗效，有助于指导个体化新辅助化疗。

Objective:To explore the application value of 64-slice spiral CT perfusion imaging in assessing angiogenesis in advanced gastric carcinoma and the efficacy of neoadjuvant chemotherapy. Methods: A total of 107 patients with advanced gastric carcinoma admitted to the hospital from September 2020 to March 2023 were selected as the subjects. All patients underwent 64-slice spiral CT examinations before neoadjuvant chemotherapy and after 2 cycles of chemotherapy to obtain CT perfusion imaging parameters of gastric carcinoma tissues and adjacent normal tissues. Microvessel density(MVD) and vascular endothelial growth factor(VEGF)protein expression levels were assessed by the immunohistochemical method. Pearson correlation analysis was used to analyze the correlation between CT perfusion imaging parameters and MVD,VEGF. Receiver operating characteristic(ROC)curves were used to analyze the value of CT perfusion imaging parameters in assessing the efficacy of neoadjuvant chemotherapy. Results: Blood flow(BF), blood volume(BV), and vascular permeability surface(PS) in gastric carcinoma tissues were higher than those in adjacent tissues(P<0.001), and were positively correlated with MVD and VEGF(P<0.001). After neoadjuvant chemotherapy, the reduction rates of BF, BV and PS in the the pathological complete remission(pCR) group were higher than those in the non-pathological complete remission(NpCR) group(P<0.001). And the reduction rates in the effective group were also higher than those in the ineffective group(P<0.001). ROC analysis showed that the area under the curve(AUC) values for predicting the efficacy of neoadjuvant chemotherapy based on the reduction rates of BF, BV and PS were 0.813, 0.762 and 0.842, respectively. Conclusion:64-slice spiral CT perfusion imaging parameters can reflect the angiogenesis status of advanced gastric carcinoma and accurately assess the pathological response and clinical efficacy after neoadjuvant chemotherapy, which is helpful for guiding individualized neoadjuvant chemotherapy.