Skip to main content

Advertisement

SpringerLink
Log in

Feasibility of integrated CT-liver perfusion in routine FDG-PET/CT

  • Published:
Abdominal Imaging Aims and scope Submit manuscript

Abstract

Objective

To integrate CT-perfusion into a routine, clinical contrast-enhanced (ce) PET/CT protocol for the evaluation of liver metastases and to compare functional CT and PET parameters.

Materials and methods

Forty-six consecutive patients (mean age: 60 (34–82) years; 20 f, 26 m) with known liver lesions (colorectal metastases (n = 34), primary liver cancer (n = 4), breast cancer (n = 3), anal cancer, gastric cancer, esophageal cancer, GIST, duodenal cancer (all: n = 1) who were referred for staging or therapy follow-up by [18F]-Fluoro-2-deoxy-D-glucose-positron-emission-tomography/computed-tomography imaging (FDG-PET/CT) were included. After acquisition of a low-dose PET/CT, a split-injection (70–90 mL) ce-CT-protocol, including a 35-s CT-perfusion scan of the liver and a diagnostic ce-CT of the thorax and/or abdomen (70 s delay, iv-contrast volume: 90 mL, 4 mL/s) was performed. CT-perfusion parameters (BF, BV, MTT,) and semi-quantitative PET-parameters (SUVmax, SUVmean, TLG, PETvol) were analyzed and compared.

Results

CT-perfusion data could be obtained in all but one patient with shallow breathing. In all patients, diagnostic ce-PET/CT quality was adequate without the use of additional contrast media. Significant correlations (P < 0.05) were found for each of BF, BV, MTT, and SUVmax, further, BF and MTT correlated with TLG. Several other correlations were seen for other perfusion and PET-parameters.

Conclusion

Combined CT-perfusion/PET/CT-protocol without the use of additional contrast media is feasible and can be easily integrated in clinical routine. Perfusion parameters and PET-parameters are only partly correlating and therefore have to be investigated further at fixed time points during the course of disease and therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Bellomi M, Petralia G, Sonzogni A, Zampino MG, Rocca A. CT perfusion for the monitoring of neoadjuvant chemotherapy and radiation therapy in rectal carcinoma: initial experience. Radiology. 2007;244:486–93

    Article  PubMed  Google Scholar 

  2. Miles KA, Griffiths MR, Keith CJ. Blood flow-metabolic relationships are dependent on tumour size in non-small cell lung cancer: a study using quantitative contrast-enhanced computer tomography and positron emission tomography. Eur J Nucl Med Mol Imaging. 2006;33:22–8

    Article  CAS  PubMed  Google Scholar 

  3. Sahani DV, Holalkere NS, Mueller PR, Zhu AX. Advanced hepatocellular carcinoma: CT perfusion of liver and tumor tissue–initial experience. Radiology. 2007;243:736–43

    Article  PubMed  Google Scholar 

  4. Sahani DV, Kalva SP, Hamberg LM, et al. Assessing tumor perfusion and treatment response in rectal cancer with multisection CT: initial observations. Radiology. 2005;234:785–92

    Article  PubMed  Google Scholar 

  5. Bisdas S, Spicer K, Rumboldt Z. Whole-tumor perfusion CT parameters and glucose metabolism measurements in head and neck squamous cell carcinomas: a pilot study using combined positron-emission tomography/CT imaging. Ajnr. 2008;29:1376–81

    Article  CAS  PubMed  Google Scholar 

  6. Groves AM, Wishart GC, Shastry M, et al. (2009) Metabolic-flow relationships in primary breast cancer: feasibility of combined PET/dynamic contrast-enhanced CT. Eur J Nucl Med Mol Imaging 36(3):416–421

    Article  PubMed  Google Scholar 

  7. Thomas JP, Arzoomanian RZ, Alberti D, et al. Phase I pharmacokinetic and pharmacodynamic study of recombinant human endostatin in patients with advanced solid tumors. J Clin Oncol. 2003;21:223–31

    Article  CAS  PubMed  Google Scholar 

  8. Wang JH, Min PQ, Wang PJ, et al. Dynamic CT Evaluation of Tumor Vascularity in Renal Cell Carcinoma. AJR Am J Roentgenol. 2006;186:1423–30

    Article  PubMed  Google Scholar 

  9. Willett CG, Boucher Y, di Tomaso E, et al. Direct evidence that the VEGF-specific antibody bevacizumab has antivascular effects in human rectal cancer. Nature medicine. 2004;10:145–7

    Article  CAS  PubMed  Google Scholar 

  10. Yi CA, Lee KS, Kim EA, et al. Solitary pulmonary nodules: dynamic enhanced multi-detector row CT study and comparison with vascular endothelial growth factor and microvessel density. Radiology. 2004;233:191–9

    Article  PubMed  Google Scholar 

  11. Schoder H, Carlson DL, Kraus DH, et al. 18F-FDG PET/CT for detecting nodal metastases in patients with oral cancer staged N0 by clinical examination and CT/MRI. J Nucl Med. 2006;47:755–62

    PubMed  Google Scholar 

  12. Schoder H, Larson SM, Yeung HW. PET/CT in oncology: integration into clinical management of lymphoma, melanoma, and gastrointestinal malignancies. J Nucl Med. 2004;45 Suppl 1:72S-81S

    PubMed  Google Scholar 

  13. Strobel K, Dummer R, Husarik DB, et al. High-risk melanoma: accuracy of FDG PET/CT with added CT morphologic information for detection of metastases. Radiology. 2007;244:566–74

    Article  PubMed  Google Scholar 

  14. Valk PE, Abella-Columna E, Haseman MK, et al. Whole-Body PET Imaging With [18F]Fluorodeoxyglucose in Management of Recurrent Colorectal Cancer. Arch Surg. 1999;134:503–11. 10.1001/archsurg.134.5.503

    Article  CAS  PubMed  Google Scholar 

  15. Veit-Haibach P, Kuehle, CA, Beyer, T, et al. (2006) Whole-body PET/CT-colonography: diagnostic accuracy of a new staging concept in patients with colorectal cancer. JAMA 296(21):2590–2600

    Article  CAS  PubMed  Google Scholar 

  16. Hillner BE, Siegel BA, Liu D, et al. Impact of positron emission tomography/computed tomography and positron emission tomography (PET) alone on expected management of patients with cancer: initial results from the National Oncologic PET Registry. J Clin Oncol. 2008;26:2155–61

    Article  PubMed  Google Scholar 

  17. Goh V, Halligan S, Gharpuray A, et al. Quantitative assessment of colorectal cancer tumor vascular parameters by using perfusion CT: influence of tumor region of interest. Radiology. 2008;247:726–32

    Article  PubMed  Google Scholar 

  18. Einstein AJ, Moser KW, Thompson RC, Cerqueira MD, Henzlova MJ. Radiation dose to patients from cardiac diagnostic imaging. Circulation. 2007;116:1290–305

    Article  PubMed  Google Scholar 

  19. Kiessling F, Boese J, Corvinus C, Ederle JR, et al. Perfusion CT in patients with advanced bronchial carcinomas: a novel chance for characterization and treatment monitoring? Eur Radiol. 2004;14:1226–33

    CAS  PubMed  Google Scholar 

  20. Meijerink MR, van Cruijsen H, Hoekman K, et al. The use of perfusion CT for the evaluation of therapy combining AZD2171 with gefitinib in cancer patients. Eur Radiol. 2007;17:1700–13

    Article  PubMed  Google Scholar 

  21. Meijerink MR, van Waesberghe JH, van der Weide L, et al. Total-liver-volume perfusion CT using 3-D image fusion to improve detection and characterization of liver metastases. Eur Radiol. 2008;18:2345–54

    Article  PubMed  Google Scholar 

  22. Miles KA (2003) Perfusion CT for the assessment of tumour vascularity: which protocol? Br J Radiol 76(spec no 1):S36–S42

    Google Scholar 

  23. Chung YE, Kim KW, Kim JH, et al. Optimal delay time for the hepatic parenchymal enhancement at the multidetector CT examination. Journal of computer assisted tomography. 2006;30:182–8

    Article  PubMed  Google Scholar 

  24. Groves AM, Wishart GC, Shastry M, et al. Metabolic-flow relationships in primary breast cancer: feasibility of combined PET/dynamic contrast-enhanced CT. European journal of nuclear medicine and molecular imaging. 2009;36:416–21. doi:10.1007/s00259-008-0948-1

    Article  PubMed  Google Scholar 

  25. Hermans R, Lambin P, Van der Goten A, et al. Tumoural perfusion as measured by dynamic computed tomography in head and neck carcinoma. Radiother Oncol. 1999;53:105–11

    Article  CAS  PubMed  Google Scholar 

  26. Kan Z, Phongkitkarun S, Kobayashi S, et al. Functional CT for quantifying tumor perfusion in antiangiogenic therapy in a rat model. Radiology. 2005;237:151–8

    Article  PubMed  Google Scholar 

  27. Sabir A, Schor-Bardach R, Wilcox CJ, et al. Perfusion MDCT enables early detection of therapeutic response to antiangiogenic therapy. AJR Am J Roentgenol. 2008;191:133–9

    Article  PubMed  Google Scholar 

  28. Akhurst T, Ng VV, Larson SM, et al. Tumor Burden Assessment with Positron Emission Tomography with. Clin Positron Imaging. 2000;3:57–65

    Article  PubMed  Google Scholar 

  29. Francis RJ, Byrne MJ, van der Schaaf AA, et al. Early prediction of response to chemotherapy and survival in malignant pleural mesothelioma using a novel semiautomated 3-dimensional volume-based analysis of serial 18F-FDG PET scans. J Nucl Med. 2007;48:1449–58

    Article  PubMed  Google Scholar 

  30. Steinert HC, Santos Dellea MM, Burger C, Stahel R. Therapy response evaluation in malignant pleural mesothelioma with integrated PET-CT imaging. Lung Cancer. 2005;49 Suppl 1:S33–5

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

we would like to thank Sabine Knoefel, RT, for her great contribution to this study.

Author information

Authors and Affiliations

  1. Department of Medical Radiology, Division of Nuclear Medicine, University Hospital Zuerich, Raemistrasse 100, 8091, Zuerich, Switzerland

    Patrick Veit-Haibach, Valerie Treyer, Klaus Strobel, Jan D. Soyka, Lars Husmann, Niklaus G. Schaefer & Thomas F. Hany

  2. Department of Medical Oncology, University Hospital Zuerich, Zuerich, Switzerland

    Niklaus G. Schaefer

  3. Department of Biostatistics, University Hospital Zuerich, Zuerich, Switzerland

    Alois Tschopp

Authors
  1. Patrick Veit-Haibach
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Valerie Treyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Klaus Strobel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jan D. Soyka
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lars Husmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Niklaus G. Schaefer
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Alois Tschopp
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Thomas F. Hany
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Patrick Veit-Haibach.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Veit-Haibach, P., Treyer, V., Strobel, K. et al. Feasibility of integrated CT-liver perfusion in routine FDG-PET/CT. Abdom Imaging 35, 528–536 (2010). https://doi.org/10.1007/s00261-009-9559-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-009-9559-y

Key words

Search

Navigation