Cristina Capraro MD, Presenter: Nothing to Disclose

Davide Ippolito MD, Abstract Co-Author: Nothing to Disclose

Luca Guerra MD, Abstract Co-Author: Nothing to Disclose

Giuseppe Di Pisa MD, Abstract Co-Author: Nothing to Disclose

Cristina Messa MD, Abstract Co-Author: Nothing to Disclose

Sandro Sironi MD, Abstract Co-Author: Nothing to Disclose

To assess the feasibility of integrated CT-perfusion (CTp) into a routine full diagnostic clinical protocol of whole-body FDG-PET/CT in patients with lung cancer in order to evaluate the relationship between perfusion measurements and glucose metabolism expressed by SUVmax.

A total of 43 consecutive patients with known or suspected lung cancer who were referred for FDG-PET/CT staging were prospectively enrolled in our study.After acquisition of a low-dose PET/CT,a split injection ce-CT protocol including a 30 sec CT-perfusion scan of the lung lesion (dynamic acquisition of 4 dynamic slice/scan; total of 30 scans;5 sec delay,i.v. administration of 50 ml of iodinated contrast;5 ml/sec) and diagnostic whole body ce-CT (60 sec scan delay;i.v. administration of 80 ml of contrast;3,5 ml/sec) were performed.CT perfusion data were used to calculate a range of parameters of tumor vascularity (BF,BV,MTTT and PS) and tumor FDG uptake (standardized uptake value,SUVmax) was used as a metabolic indicator.

The perfusion images were analyzed by using a commercially available software (Perfusion 3,0;Advantage;GE) which generated a quantitative map of arterial perfusion.A significant difference (p<0.001) was noted in relation to the location,between upper and lower lobe tumor (mean value BV:16,1 vs 9,1 ml/100g;m.v. PS 9,6 vs 17,4 ml/min/100g,respectively) and in relation to the size (p<0.001) between tumor <3 cm and tumor >3 cm (m.v. BV:7,7 vs 15,4 ml/100g;m.v. MTT:5,7 vs 9,2sec;m.v. PS 7,7 vs 14,2 ml/min/100g,respectively).The mean SUV max values calculated at the same position were 7,9±6,7 and 11,3±6,2,respectively.A significant correlation (linear regression) between BF, MTT and SUVmax was found (p<0.05) for the lesion with <3 cm diameter.

The integrated CT-perfusion protocol into a ce-PET/CT examination appears to be a technically feasible and promising tool in characterizing lung lesions, without use of additional contrast compared to a standard ce-PET/CT study.

CT-perfusion imaging combined with PET/CT provide functional information about tumor vasculature and tumor pathophisiology related to metabolism and angiogenesis,thus helping the therapeutic approach.

Capraro, C, Ippolito, D, Guerra, L, Di Pisa, G, Messa, C, Sironi, S, Feasibility of CT Perfusion Integrated in Routine Whole Body CE-FDG-PET/CT Study in Lung Cancer Patients: Clinical Staging and Relationship of Perfusion Measurements and Glucose Metabolism Parameters.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9008046.html