J Korean Soc Radiol.  2016 Nov;75(5):354-362. 10.3348/jksr.2016.75.5.354.

Evaluation of Dual-Input Perfusion in Lung Cancer Using a 320-Detector CT: Its Correlation with Tumor Size, Location, and Presence of Metastasis

• Kang EJ
• Lee KN
• Han JY
• Roh MS
• Son C

• KMID: 2355989
• DOI: http://doi.org/10.3348/jksr.2016.75.5.354

Abstract

PURPOSE
The purposes of our study were to assess the dual blood supply of lung cancer using a computed tomography (CT) perfusion technique, and to analyze the correlations between dual perfusion and various characteristics of lung cancer.
MATERIALS AND METHODS
Thirty-five consecutive patients with lung tumors highly suggestive of malignancy were included in this study. All subjects underwent a dual-input dynamic perfusion volume scan using a 320-detector-row CT before CT-guided biopsy. The pulmonary trunk and the descending thoracic aorta were selected for the arterial input functions. From the CT data, pulmonary arterial perfusion (PP), aortic perfusion (AP), and the perfusion index [PI = PP / (PP + AP)] were calculated using the dual-input maximum-slope method. We statistically analyzed the relationship of the perfusion data with tumor locations (central, peripheral, and abutting the pleural lesions), tumor volumes, and the presence of lymph node metastasis or distant metastasis.
RESULTS
All subjects were pathologically diagnosed with primary lung cancers via CT-guided aspiration biopsy. The overall mean PI was 53.7 ± 7.2%. The PI showed a significant difference according to the tumor location (central, 49.2 ± 3.3%; peripheral, 56.2 ± 6.7%; abutting the pleural lesions, 48.9 ± 7.6%, p = 0.047). In contrast, no significant difference was detected in tumor size or the presence of metastasis (p > 0.05).
CONCLUSION
We found that the proportion of dual perfusion in lung cancer was significantly dependent on the location of the tumor, while tumor size or the presence of metastasis was not distinctly associated with dual perfusion.

MeSH Terms

Aorta, Thoracic
Biopsy
Biopsy, Needle
Humans
Lung Neoplasms*
Lung*
Lymph Nodes
Methods
Neoplasm Metastasis*
Perfusion*
Pulmonary Circulation
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Dynamic perfusion CT protocol. After the tumor location (arrows) (A) is identified, the z-axis coverage is determined to include the main pulmonary artery (PA) and the left atrium (LA) by using a CT scanogram. Placement of elliptical regions of interest in the pulmonary trunk, the descending aorta, and the LA to generate a time-density curve (TDC) (B, C). D. TDC of the PA (blue line), lung cancer (green line), LA (orange line) and aorta (red line). The peak time point of LA (Max) is used to differentiate the pulmonary circulation between the pulmonary arterial circulation (regarded as the before-peak time point) and the systemic arterial circulation (regarded as the after-peak time point). The pulmonary trunk represents the pulmonary arterial input function and the descending thoracic aorta represents the systemic arterial input function. The automatically generated perfusions maps (E-G) of pulmonary arterial perfusion (PP) (E), aortic perfusion (AP) (F), and perfusion index (PI) (G). HU = Hounsfield unit

• 

  Fig. 2 Representative cases of each location of lung tumors. A. Axial CT scan in a 80-year-old male with adenocarcinoma (arrows) abutting the right upper lobar bronchus with direct invasion, which was classified as having a central location (PP, 119.1 mL/min/100 mL; AP, 111.3 mL/min/100 mL; PI, 50.2%; tumor volume, 10.2 mL). B. Axial CT scan in a 77-year-old female with small cell carcinoma (arrows) surrounded by lung parenchyma and located in the left upper lobe, which was classified as having a peripheral location (PP, 60.8 mL/min/100 mL; AP, 90.5 mL/min/100 mL; PI, 60.2%; tumor volume, 17.7 mL). C. Axial CT scan in a 67-year-old male with squamous cell carcinoma (arrows) in the left upper lobe with a wide base at the pleura, which was classified as abutting the pleural lesions (PP, 97.9 mL/min/100 mL; AP, 97.6 mL/min/100 mL; PI, 50.1%; tumor volume, 12.7 mL). AP = aortic perfusion, PI = perfusion index [PI = PP / (PP + AP)], PP = pulmonary arterial perfusion

• 

  Fig. 3 Scatter plots of tumor volume and perfusion parameters. No significant correlation is observed between tumor volume and PP (A), AP (B), and PI (C). AP = aortic perfusion, PI = perfusion index [PI = PP / (PP + AP)], PP = pulmonary arterial perfusion

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