Perfusion CT in patients with advanced bronchial carcinomas: a novel chance for characterization and treatment monitoring?

Abstract

Advanced bronchial carcinomas by means of perfusion and peak enhancement using dynamic contrast-enhanced multislice CT are characterized. Twenty-four patients with advanced bronchial carcinoma were examined. During breathhold, after injection of a contrast-medium (CM), 25 scans were performed (1 scan/s) at a fixed table position. Density-time curves were evaluated from regions of interest of the whole tumor and high- and low-enhancing tumor areas. Perfusion and peak enhancement were calculated using the maximum-slope method of Miles and compared with size, localization (central or peripheral) and histology. Perfusion of large tumors (> 50 cm3) averaged over both the whole tumor (P = 0.001) and the highest enhancing area (P = 0.003) was significantly lower than that of smaller ones. Independent of size, central carcinomas had a significantly (P = 0.04) lower perfusion (mean 27.9 ml/min/100 g) than peripheral ones (mean 66.5 ml/min/100 g). In contrast, peak enhancement of central and peripheral carcinomas was not significantly different. Between non-small-cell lung cancers and small-cell lung cancers, no significant differences were observed in both parameters. In seven tumors, density increase after CM administration started earlier than in the aorta, indicating considerable blood supply from pulmonary vessels. Tumor perfusion was dependent on tumor size and localization, but not on histology. Furthermore, perfusion CT disclosed blood supply from both pulmonary and/or bronchial vessels in some tumors.

Assessment of Bronchial and Pulmonary Blood Supply in Non-Small Cell Lung Cancer Subtypes Using Computed Tomography Perfusion

“…This implies an increase in pulmonary blood supply with growing tumor size. Our findings correspond reasonably to the results of the study by Kiessling et al, 37 who found lower perfusion in tumors larger than 50 mm 3 , using a bronchial arterial system analysis. Tumor volume certainly reflects the actual tumor size more exactly than does the maximum diameter alone.…”

The Role of First-Pass Perfusion Computed Tomography in the Differentiation of Centrally Located Lung Cancer and Distal Atelectasis

“…and PE (peak enhancement) parameters between SCLC and NSCLC cases [1]. We also did There were also some factors with a negative influence on CT perfusion in our study.…”

“…The use of non-invasive functional imaging methods in the detection, staging and follow-up of lung cancer has gradually become routine in clinical applications [1]. Perfusion CT is one of these methods and is a promising technique that allows functional evaluation of tissue vascularity [2].…”

Role of Perfusion Computed Tomography in the Characterization of Lung Cancers

“…(Table 1) Location of Lung Cancer and Perfusion Parameters Central tumour was defined as having contact to the hilum, whereas all other tumours were considered peripheral. 6 All SCLC were centrally located (2/2 i.e. 100%), whereas SCC (11/16 i.e.68.75%) and Adenocarcinoma (7/10 i.e.…”

“…14 Keisling et al and Li Y et al also observed significantly higher perfusion in smaller tumours than larger one. 6,15 Several mechanisms have been advocated to explain why large tumours are poorly vascularized and have a poor prognosis. The decrease in micro vessel density (MVD) reflects the inability of tumour neovascularization to support the fast proliferation of the tumour cells, leading to a reduced vascular supply, resulting in necrosis, which is very frequent in larger lesions.…”