Whole tumour perfusion of peripheral lung carcinoma: evaluation with first-pass CT perfusion imaging at 64-detector row CT

Aim: To prospectively assess the feasibility of a whole-tumour perfusion technique using 64-detector row computed tomography (CT) and to analyse the variation of CT perfusion parameters in different histological types, sizes, and metastases in patients with peripheral lung carcinoma. Methods and materials: Ninety-seven pathologically proved peripheral lung carcinomas (less than 5 cm in largest diameter) underwent dynamic contrast-enhanced CT using a 64-detector row CT machine. Small amounts of iodinated contrast medium with a sharp bolus profile (50 ml, 6-7 ml/s), and 12 repeated fast acquisitions encompassing the entire tumour lesion were adopted to quantify perfusion of the whole-tumour during first-pass of contrast medium. Four kinetic parameters, including perfusion, peak enhancement intensity (PEI), time to peak (TTP), and blood volume (BV), were measured and statistically compared among different histological types, sizes, and metastases. Results: Mean values for perfusion, PEI, TTP, and BV of the 97 lung carcinomas were 57.5 ± 45.4 ml/min/ml (range 5.9-243 ml/min/ml), 53.4 ± 40.6 HU (range 10.3-234.4 HU), 34 ± 11 s (range 11-60 s), and 30.1 ± 21.7 ml/100 g (range 3.9-113.4 ml/100 g), respectively. No statistical differences were found between the histological types regarding the perfusion parameters (p > 0.05). Perfusion, PEI, and BV of stage T2 tumours were significantly lower than those of stage T1 tumours (all p < 0.05), whereas no statistically significant differences was found between other stages of tumours (all p > 0.05). Perfusion of the tumours with distant metastasis was significantly higher than that of the tumours without distant metastasis (p < 0.05), but there was no statistically significant difference between nodal metastasis positive and negative groups (p > 0.05). Conclusion: The present study of first-pass perfusion imaging using 64-detector row CT could provide a feasible method for assessment of whole-tumour perfusion. CT perfusion parameters of peripheral lung carcinoma may be associated with tumour size and distant metastasis