Max Wintermark MD, Moderator: Research Grant, General Electric Company Research Grant, Koninklijke Philips NV

1) To understand the principles of CT perfusion analysis for tumor assessment. 2) To understand the pathophysiological basis of CT perfusion parameters for tumors. 3) To understand unique CT perfusion analysis of the liver due to its characteristic dual blood supply. 4) To describe the potential clinical applications, with a focus on hepatic and extrahepatic applications & clinical trials. 5) To discuss several recent challenging issues regarding CT perfusion. 6) To discuss areas for further development including assessment of tumor heterogeneity.

With the emergence of novel targeted therapies for cancer, imaging techniques that assess tumor vascular support have gained credence for response assessment alongside standard response criteria. CT perfusion techniques that quantify regional tumour blood flow, blood volume, flow-extraction product, and permeability-surface area product through standard kinetic models, are attractive in this scenario by providing evidence of a vascular response or non-response. Additionally, these techniques may provide prognostic and predictive information to the clinician. Their increasing acceptance in oncological practice in recent years has been related to the combination of clinical need and technological improvements in CT, including faster tube rotation speeds, higher temporal sampling rates, the development of dynamic 3D acquisitions and development of commercial software programmes embedded within the clinical workflow. Recently published consensus guidelines provide a way forward to perfoming studies in a more standardized manner. To date single centre studies have provided evidence of clinical utility. Future studies that include good quality prospective validation correlating perfusion CT to outcome endpoints in the trial setting are now needed to take CT perfusion forward as a biomarker in oncology. These presentations will cover the principles of CT perfusion analysis for tumor assessment and its pathophysiological basis. Clinical applications will be discussed focusing on hepatic and extrahepatic applications & clinical trials. Areas for further development including assessment of tumor heterogeneity will also be discussed.

Wintermark, M, Quantitative CT and MR Perfusion Imaging.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/13011409.html