Differential diagnostic value of computed tomography perfusion combined with vascular endothelial growth factor expression in head and neck lesions

Abstract

There are numerous types of head and neck lesions (HNLs), and conventional computed tomography (CT) has low specificity and sensitivity in the definitive and differential diagnosis of HNLs. The aim of the present study was to evaluate the value of perfusion CT (CTP) combined with vascular endothelial growth factor (VEGF) expression in the differentiation between malignant and benign HNLs. In total, 41 HNLs, which were pathologically confirmed, underwent CTP and VEGF expression analysis. All lesions were divided into three groups: Group A, benign hypovascular lesions; Group B, benign hypervascular lesions; and Group C, malignant lesions. Time density curve (TDC) and CTP parameters [maximum intensity projection (MIP), blood volume (BV), blood flow (BF), mean transit time and capillary permeability] were analyzed. The association between perfusion measurements and VEGF was assessed using Pearson's correlation. TDCs were classified into three types, and type I was more frequently identified in benign tumors (Groups A and B) compared with malignant tumors (Group C) (P=0.003). Malignant tumors primarily had a TDC of type II and III. MIP, BF and BV were all significantly higher in Groups B and C compared to Group A (P<0.01). VEGF expression of malignant tumors was significantly higher than benign tumors (P=0.007). No correlation was identified between VEGF and any CTP parameter. The present findings suggest that CTP combined with VEGF may differentiate between malignant and benign HNLs, and between benign hypovascular and hypervascular lesions.

Keywords: angiogenesis; computed tomography; head and neck lesions; perfusion; vascular endothelial growth factor.

Figure 1.

A 50-year-old female of Group A with pleomorphic adenoma in the left parotid. (A) Axial contrast-enhanced CT shows an irregular mass with heterogeneous enhancement (arrow). (B-F) CT perfusion functional maps show that the lesion has relatively (B) increased MIP, and decreased (C) BV, (D) BF, (E) CP and (F) MTT compared with the contralateral normal parotid gland. (G) Time density curve of type I; a steep ascending phase with no descending phase. (H) Vascular endothelial growth factor expression is weakly positive; brown staining is observed in the tumour cytoplasm and cytomembrane (arrow; magnification, ×400). CT, computed tomography; MIP, maximum intensity projection; BV, blood volume; BF, blood flow; MTT, mean transit time; CP, capillary permeability.

Figure 2.

A 50-year-old female of Group C with a mucoepidermoid carcinoma in the right parotid. (A) Axial contrast-enhanced CT shows an ill-defined mass with heterogeneous enhancement (arrow). (B-F) CT perfusion functional maps show that the lesion has relatively increased (B) MIP, (C) BV and (D) BF, and decreased (E) CP and (F) MTT compared with the contralateral normal parotid gland. (G) Time density curve of type II with a steep ascending phase and an apparent descending phase. (H) VEGF expression is strongly positive; brown staining was observed in the tumour cytoplasm (arrow; magnification, ×400). CT, computed tomography; MIP, maximum intensity projection; BV, blood volume; BF, blood flow; MTT, mean transit time; CP, capillary permeability.