Quantitative evaluation of first pass perfusion in lung cancers with multidetector computed tomography

In this study, we aimed to differentiate lung cancers in terms of histologic types, localizations, solidarity and necrotic features using the first-pass perfusion CT parameters.Our study consisted of 44 patients (38 male and 6 female) who were diagnosed as lung cancer due to cytological and/or histopathological evaluations. The patients without a history of radiotherapy and chemotherapy were involved in the study.The CT images included scout and standard unenhanced images. The slices were determined so as to include the mass-consolidation area, and the dynamic study was performed with respect to perfusion CT protocols. The images were transformed to a workstation followed by color perfusion mapping. The perfusion parameter measurements were performed by placing ROI on 3 different locations of the mass, avoiding the necrotic and cystic areas as possible. The BV, BF, TTP and MTT perfusion parameters were recorded.Our study demonstrated that BF, BV and MTT values were higher in peripheral lung cancers in comparison to centrally located lung masses regardless of histopathological diagnoses. The mean perfusion parameters in peripheral lung cancers were measured as BV: 9,62±2,3, BF: 60,05±15,49, MTT: 13,56±3,91, respectively and BV: 5,65±2,96, BF: 30,45± 11,25, MTT: 10,13±3,01 in centrally located lung cancers. Also, in solid lung cancers BV and BF perfusion CT parameters were detected higher than the necrotic lung cancers. The mean BV in solid lung cancers was 7.03±3.51 and the mean BF was 40.51±18.52 whereas BV: 5.40±2.32 and BF: 29.23±11.72 in necrotic lung cancers.In conclusion, first-pass perfusion CT offered valuable information about non-invasive evaluation of tumor perfusion in lung cancers and tumor angiogenesis. We conclude that peripheral and solid lung cancers may benefit from treatments like anti-angiogenetic drugs, radiotherapy and chemotherapy more than centrally located and necrotic lung cancers. It seems that perfusion CT may play a greater role in the evaluation of the effectiveness of these treatments.