Perfusion CT in Colorectal Cancer: Comparison of Perfusion Parameters with Tumor Grade and Microvessel Density

Abstract

ObjectiveThe purpose of this study was to prospectively compare pre-operative computed tomography (CT) perfusion parameters with tumor grade from colorectal adenocarcinoma (CRC) and to correlate pre-operative CT perfusion parameters with microvessel density (MVD) to evaluate angiogenesis in CRC.Materials and MethodsPre-operative perfusion CTs were performed with a 64-channel multidetector row CT in 27 patients (17 women and 10 men; age range 32-82 years) who were diagnosed with CRC involving the sigmoid and rectum between August 2006 and November 2007. All patients underwent surgery without pre-operative chemotherapy or radiation therapy. Dynamic perfusion CTs were performed for 65 seconds after intravenous injection of contrast medium (100 mL, 300 mg of iodine per mL, 5 mL/sec). Before surgery, blood flow (BF), blood volume, mean transit time (MTT), and permeability-surface area product were measured in the tumor. After surgery, one gastrointestinal pathologist evaluated tumor grade and performed immunohistochemical staining using CD 34 to determine MVD in each tumor. The Kruskal-Wallis test was used to compare CT perfusion parameters with tumor grade, and Pearson's correlation analysis was used to correlate CT perfusion parameters with MVD.ResultsIn 27 patients with CRC, tumor grading was as follows: well differentiated (n = 8); moderately differentiated (n = 15); and poorly differentiated (n = 4). BF was higher in moderately differentiated CRC than well differentiated and poorly differentiated CRCs (p = 0.14). MTT was shorter in moderately differentiated than well differentiated and poorly differentiated CRCs (p = 0.039). The MVD was greater in poorly differentiated than well differentiated and moderately differentiated CRCs (p = 0.034). There was no significant correlation between other perfusion parameters and tumor grade. There was no significant correlation between CT perfusion parameters and MVD.ConclusionBF and MTT measurement by perfusion CT is effective in predicting moderately differentiated CRCs. However, perfusion CT is limited in distinguishing well differentiated and poorly differentiated CRCs. Pre-operative perfusion CT does not reflect the MVD of CRCs.

CT Perfusion of the Liver: Principles and Applications in Oncology

“…The contrast agent present protocols within the same imaging session. Several studies have shown that CT perfusion parameters correlate well with the presence and extent of tumor vessels (18)(19)(20), which could be leveraged for earlier detection of liver malignancies and more individualized monitoring of patients during treatment. In addition, CT perfusion can be integrated with PET examinations, allowing assessment of both the hemodynamic and metabolic tumor status.…”

Compartment model analysis of intravenous contrast‐enhanced dynamic computed tomography in hepatic hemodynamics: A validation study using intra‐arterial contrast‐enhanced computed tomography

“…Second, the biological relevance of the k 2 limits is unknown, even though we validated both k 1a and k 1p using IA‐CT. The k 2 is also expressed as the inverse of mean transit time, whose usefulness in the evaluation of liver diseases has been reported by several studies . However, a gold standard method to validate k 2 is lacking, because it is an apparent value in the calculation of CMA.…”

“…Various useful tissue hemodynamic parameters can be quantitatively obtained from a CT perfusion study. Several studies have shown that the parameters obtained from a CT perfusion study correlate well with the presence and range of tumor vessels . Although CT perfusion studies are known to be useful in the assessment of hepatic perfusion associated with disease severity in patients with chronic liver disease, earlier detection of liver malignancies, and evaluation of treatment effects in HCC, no validation study has been conducted to date between IA‐CT and a liver perfusion study using IV‐CT.…”

In VitroandIn VivoImaging of Prostate Cancer Angiogenesis Using Anti-Vascular Endothelial Growth Factor Receptor 2 Antibody-Conjugated Quantum Dot

“…There are several reports for imaging the angiogenesis in animal and clinical studies (29-31). Jun et al (29) tried to visualize the tumor angiogenesis using a VEGF receptor 2 antibody conjugated magnetic resonance contrast agent, and Ko et al (30) evaluated angiogenesis using an ultrasound contrast agent, using animal models.…”

“…Jun et al (29) tried to visualize the tumor angiogenesis using a VEGF receptor 2 antibody conjugated magnetic resonance contrast agent, and Ko et al (30) evaluated angiogenesis using an ultrasound contrast agent, using animal models. In a clinical study, Kim et al (31) compared the perfusion parameters in CT with tumor grade and microvessel density.…”